title: [Pubic tubercle side approach to the obturator nerve block].
abstract: BACKGROUND
  The authors describe the pubic tubercle side approach of the obturator nerve block for the management of adductor muscle constriction associated with the transurethral resection of the lateral wall bladder tumor.
  
  
  METHODS
  The pubic tubercle side approach of the obturator nerve block was performed by a inserting needle at the midpoint of the femoral artery and the pubic tubercle. After the needle encountered the superior ramus of pubis, the needle was redirected vertical or slightly caudal, passeing the vicinity of the inferior margin of the superior ramus of pubis, and then advanced to the trunk of the obturator nerve. The obturator nerve was identified by its response to nerve stimulation. The pubic tubercle side approach using more than 5 ml of 1.0% lidocaine was performed by a single injection until there was no response to nerve stimulation. On the other hand, by the traditional approach to the obturator nerve block, after the initial local anesthetic injection the needle was redirected lateral and slightly caudal. If the response to nerve stimulation was still elicited, more local anesthetic was administered.
  
  
  RESULTS
  Evaluation of the efficacy of the pubic tubercle side approach was performed in-terms of quantity of the local anesthetic used and the success rate. In comparison with the traditional approach, a smaller dose of local anesthetic was used in spite of the higher success rate.
  
  
  CONCLUSIONS
  The pubic tubercle side approach of the obturator nerve was useful and without complications in comparison with the traditional approach.
authors.affiliation: Department of Anesthesia, Minoh City Hospital, Minoh 562-8562.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.forename: Luna
authors.initials: L
authors.lastname: Nishihara
authors.forename: Katsuji
authors.initials: K
authors.lastname: Tomi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D009776:Obturator Nerve; D011630:Pubic Bone; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D013520:Urologic Surgical Procedures
chemical_list: D000779:Anesthetics, Local