Selective blocking of the anterior branch of the obturator nerve in children with cerebral palsy.
OBJECTIVE
To evaluate the effect of selective blocking of the anterior branch of the obturator nerve by using phenol in controlling adductor spasticity in children with cerebral palsy.


METHODS
To study the anatomic location of the anterior branch of the obturator nerve with respect to bony landmarks in the inguinal area, 12 limbs of seven adult cadavers were anatomically dissected. We injected 22 anterior branches of obturator nerves in 11 children with spastic cerebral palsy with 5% aqueous phenol guided by anatomical landmarks and electrical stimulation. The range of motion (ROM) of hip abduction and the modified Ashworth scale (MAS) grade of the hip adductors were measured preinjection, and at 1, 3, 6, and 12 mos after injection.


RESULTS
Successful clinical results (range of hip abduction greater than 45 degrees with the knee extended) were achieved in all the children immediately after the injection. The average volume of 5% aqueous phenol injected per nerve was 0.79 +/- 0.20 ml (0.12 +/- 0.02 ml/kg). The effect was maintained for more than 6 mos. No immediate or delayed complications were observed.


CONCLUSIONS
Selective blocking of the anterior branch of the obturator nerve with 5% aqueous phenol can safely and effectively control adductor spasticity in children with cerebral palsy.
Kwon
Jeong-Yi
JY
Catholic University of Korea, Department of Physical Medicine and Rehabilitation, St. Vincent Hospital, Suwon, Korea.
Kim
Joon-Sung
JS
D000704:Analysis of Variance; D002102:Cadaver; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D003933:Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000503:physiopathology; D009407:Nerve Block / Q000379:methods*; D009776:Obturator Nerve / Q000187:drug effects*; D010636:Phenols / Q000627:therapeutic use*; D010865:Pilot Projects
D010636:Phenols