title: A Cadaveric Study of Ultrasound-Guided Subpectineal Injectate Spread Around the Obturator Nerve and Its Hip Articular Branches.
abstract: OBJECTIVE
  The femoral and obturator nerves are assumed to account for the primary nociceptive innervation of the hip joint capsule. The fascia iliaca compartment block and the so-called 3-in-1-block have been used in patients with hip fracture based on a presumption that local anesthetic spreads to anesthetize both the femoral and the obturator nerves. Evidence demonstrates that this presumption is unfounded, and knowledge about the analgesic effect of obturator nerve blockade in hip fracture patients presurgically is thus nonexistent. The objectives of this cadaveric study were to investigate the proximal spread of the injectate resulting from the administration of an ultrasound-guided obturator nerve block and to evaluate the spread around the obturator nerve branches to the hip joint capsule.
  
  
  METHODS
  Fifteen milliliters of methylene blue was injected into the interfascial plane between the pectineus and external obturator muscles in 7 adult cadavers. The spread of the injectate into the obturator canal and around the obturator and accessory obturator nerve branches to the hip joint was evaluated by subsequent dissection.
  
  
  RESULTS
  The injected dye spread into the obturator canal and colored all obturator branches to the hip joint capsule in all 14 sides. Furthermore, the accessory obturator nerve was present in 3 sides (21%), and the nerve and its branches to the hip joint capsule were colored in all cases.
  
  
  CONCLUSIONS
  In cadavers, injection of 15 mL of methylene blue into the interfascial plane between the pectineus and the external obturator muscle effectively spreads proximally to reach the obturator canal, as well as the obturator nerve branches to the hip joint capsule and the accessory obturator nerve.
authors.affiliation: From the *Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; †Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria; and ‡Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus; and §Department of Anesthesiology, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Nielsen
authors.forename: Bernhard
authors.initials: B
authors.lastname: Moriggl
authors.forename: Kjeld
authors.initials: K
authors.lastname: Søballe
authors.forename: Jens A
authors.initials: JA
authors.lastname: Kolsen-Petersen
authors.forename: Jens
authors.initials: J
authors.lastname: Børglum
authors.forename: Thomas Fichtner
authors.initials: TF
authors.lastname: Bendtsen
mesh_terms: D002102:Cadaver; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000187:drug effects* / Q000294:innervation; D006801:Humans; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage*; D009776:Obturator Nerve / Q000000981:diagnostic imaging* / Q000187:drug effects*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D008751:Methylene Blue