Ultrasound-guided obturator nerve block: a preliminary report of a case series.
OBJECTIVE
Obturator-nerve block improves analgesia for knee surgery. Traditional techniques rely on surface landmarks, which can be variable and result in excessive performance times and multiple needle passes. The objective of this study was to evaluate a novel ultrasound-guided technique for localizing the obturator nerve.


METHODS
A total of 22 patients undergoing anterior cruciate ligament repair had ultrasound-guided obturator-nerve blocks. Needles were directed under real-time ultrasound guidance. Endpoint for injection consisted of identifying contact of the tip of an insulated needle to nerve confirmed by adductor muscles' contraction. Local anesthetic was injected, and block was evaluated within 30 minutes. After that, ultrasound-guided sciatic-femoral blocks were placed for surgical purposes. Data collected included: time required for nerve identification, minimum stimulating current, number of attempts for correct identification, preblock and postblock adductor muscles' strength, sensory-nerve block, and quality of surgical anesthesia.


RESULTS
In 91% of cases, the obturator nerve was correctly identified on first attempt within 30 +/- 23 seconds, as a hyperechoic flat or lip-shaped structure with internal hypoechoic dots. Minimal intensity of current to nerve stimulation was 0.30 +/- 0.08 mA. All patients exhibited decreases in adductor strength. Sensory territories were variable, with no cutaneous distribution in 32% of the patients. Small-dose opioid supplementation was required in 14% of the patients, but none required general anesthesia to complete surgery.


CONCLUSIONS
These preliminary data suggest that ultrasound-guided obturator-nerve identification and block are technically easy and highly successful.
Helayel
Pablo Escovedo
PE
Department of Anesthesiology, Nucleus for Teaching and Research in Regional Anesthesia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil. pehelayel@hotmail.com
da Conceição
Diogo Brüggemann
DB
Pavei
Patrícia
P
Knaesel
Julian Alexander
JA
de Oliveira Filho
Getúlio Rodrigues
GR
D000328:Adult; D000577:Amides; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D004558:Electric Stimulation; D005260:Female; D005267:Femoral Nerve / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000294:innervation; D009407:Nerve Block; D009776:Obturator Nerve / Q000000981:diagnostic imaging*; D010146:Pain / Q000517:prevention & control*; D010865:Pilot Projects; D011446:Prospective Studies; D000077212:Ropivacaine; D012584:Sciatic Nerve / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine