A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies.
BACKGROUND
Obturator nerve block is highly recommended for knee surgery in addition to a femoral nerve block. The main disadvantage of the classic approach at the pubic tubercle is low patient acceptance due to pain and discomfort. The authors hypothesized that the use of a new inguinal obturator nerve block technique would reduce pain and discomfort in patients.


METHODS
The inguinal approach was simulated in five fresh cadavers. Injection of latex was performed in two cadavers. The location of the needle and the extent of latex solution were analyzed. Fifty patients scheduled to undergo arthroscopic knee surgery were randomly assigned to receive obturator nerve block using either the inguinal (n = 25) or the pubic tubercle approach (n = 25).


RESULTS
In all cadavers, the needle was close to the obturator nerve branches, which were surrounded by the latex solution. In the clinical study, visual analog scale pain scores and discomfort of block placement were significantly lower in the inguinal group compared with the pubic tubercle group (P < 0.01). In the inguinal group, there was a significant decrease in block performance time (P < 0.05) and in bolus of propofol and fentanyl used for the procedure (P < 0.01). Twenty minutes after application of the block, adductor strength decrease, occurrence, and location of cutaneous distribution of the obturator nerve were not significantly different between the groups. The incidence of minor complications was significantly increased in the pubic tubercle group (P < 0.05). No major complications were observed.


CONCLUSIONS
The new inguinal approach decreases patient discomfort and pain of block placement as well as the time and sedation and analgesics required for a similar quality of sensory and motor block compared with the pubic tubercle approach.
Choquet
Olivier
O
Department of Anesthesiology and Critical Care Medicine, La Conception University Hospital, Marseille, France.
Capdevila
Xavier
X
Bennourine
Khaled
K
Feugeas
Jean-Louis
JL
Bringuier-Branchereau
Sophie
S
Manelli
Jean-Claude
JC
D000759:Adjuvants, Anesthesia; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous; D001182:Arthroscopy; D005260:Female; D005267:Femoral Nerve; D005283:Fentanyl; D006801:Humans; D007264:Inguinal Canal; D007717:Knee / Q000601:surgery; D007840:Latex; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D009776:Obturator Nerve; D010147:Pain Measurement; D015742:Propofol
D000759:Adjuvants, Anesthesia; D018686:Anesthetics, Intravenous; D007840:Latex; D005283:Fentanyl; D015742:Propofol