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At least 19 recordsLinked to original sources
PubMed1987

[Controlled obturator nerve block using electrostimulation: prevention of the stimulation of the obturator nerve during resection of the lateral walls of the bladder].

An adductor contraction secondary to obturator nerve stimulation can occur during transurethral resection of a lateral bladder lesion and then can induce bladder perforation or hamper complete resection. Many technique have been advocated but they are ineffective or unreliable. Obturator nerve blockade in the obturator canal by local anesthesia with control by nerve stimulator can prevent these complications. The technique described, has been used in 12 patients it is reliable, fast and easy to perform.

Anesthesia, Local↗
PubMed1991

[A report on 107 cases of obturator nerve block].

The obturator nerve passes in close proximity to the inferolateral bladder wall. Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective to stop adductor spasm during spinal anesthesia. We performed obturator nerve block in 107 cases by use of insulated needle and nerve stimulator, and measured the depth of the obturator nerve and that of the pubic tubercle. Obesity index was positively correlated with the depth of the obturator nerve as well as the pubic tubercle. However, no correlation was found between the obesity index and the difference of the depth of the obturator nerve and the depth of the pubic tubercle. It is suggested that if the needle is advanced in the direction of the obturator canal about 40mm further after reaching the pubic tubercle, the needle reaches the obturator nerve.

Adult↗
PubMed1984

Use of nerve stimulator for simple and accurate obturator nerve block before transurethral resection.

Adductor contraction from obturator nerve stimulation occurs frequently in certain situations during transurethral operations. Bladder perforation is a common result. A simple and safe technique involving use of a nerve stimulator for accurate obturator blockade is described. There have been no adductor contractions in more than 275 transurethral resections during a 2-year interval. There were no complications from the block itself or use of the nerve stimulator.

Electric Stimulation↗
PubMed2002

An evaluation of the cutaneous distribution after obturator nerve block.

UNLABELLED: In 1973, Winnie et al. introduced the inguinal paravascular three-in-one block, which allegedly provides anesthesia of three nerves--the femoral, lateral cutaneous femoral, and obturator nerves--with a single injection. This concept was undisputed until the success of the obturator nerve block was reassessed by using evidence of adductor weakness rather than cutaneous sensory blockade, the latter being variable in its distribution and often absent. We performed this study, therefore, to evaluate the area of sensory loss produced by direct injection of local anesthetic around the obturator nerve. A selective obturator nerve block with 7 mL of 0.75% ropivacaine was performed in 30 patients scheduled for knee surgery. Sensory deficit and adductor strength were evaluated for 30 min by using sensory tests (cold and light-touch perception) and the pressure generated by the patient's squeezing a blood pressure cuff placed between the knees. Subsequently, a three-in-one block was performed, and the sensory deficit was reassessed. The obturator nerve block was successful in 100% of cases. The strength of adductors decreased by 77% +/- 17% (mean +/- SD). In 17 patients (57%), there was no cutaneous contribution of the obturator nerve. The remaining 7 patients (23%) had an area of hypoesthesia (cold sensation was blunt but still present) on the superior part of the popliteal fossa, and the other 6 (20%) had sensory deficit located at the medial aspect of the thigh. The three-in-one block resulted in blockade of the lateral aspect of the thigh in 87% of cases, whereas the anteromedial aspect was always anesthetized. By use of magnetic resonance imaging in eight volunteers, we demonstrated that the obturator nerve has already divided into its two branches at the site of local anesthetic injection. However, the injection of blue dye after having simulated the technique in five cadavers showed that the fluid regularly spread to both branches. We conclude that after three-in-one block, a femoral nerve block may have been assessed as an obturator nerve block in 100% of cases when testing the cutaneous distribution of the obturator nerve on the medial aspect of the thigh. IMPLICATIONS: Previous studies reporting an incidence of obturator nerve block after three-in-one block may have mistaken a femoral nerve block for an obturator nerve block in 100% of cases when the cutaneous distribution of the obturator nerve was assessed on the medial aspect of the thigh. The only way to effectively evaluate obturator nerve function is to assess adductor strength.

Amides↗
PubMed1980

Prevention of obturator nerve stimulation during transurethral surgery.

The obturator nerve passes in close proximity to the inferolateral bladder wall, bladder neck and lateral prostatic urethra. During a transurethral operation resection in these areas may result in stimulation of the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To block this reaction d-tubocurarine and succinylcholine can be used during general anesthesia. However, it often is preferable to use spinal anesthesia during transurethral operations. Local anesthetic blockade of the obturator nerve as it passes through the obturator canal if effective for adductor spasm during spinal anesthesia. We herein describe the anatomy, pharmacology, technique and results of local obturator nerve blockade.

Anesthesia, Spinal↗
PubMed1988

Bilateral obturator nerve injuries during urologic surgery.

Obturator nerve injury can result from prolonged acute hip flexion. Bilateral obturator nerve compromise developed in a patient as a result of prolonged urologic surgery. The clinical and electromyographic findings were consistent with this diagnosis. The nerve injury was believed to result from stretching at the bony obturator foramen. Management included a trial of steroids, gait training, and instruction on avoiding acute hp flexion. The clinical and EMG abnormalities disappeared. Awareness of this occurrence and an understanding of the anatomy may avoid confusion with other conditions and permit accurate diagnosis.

Adult↗
PubMedDate not supplied

[Obturator nerve block in transurethral surgery].

The obturator nerve passes in close proximity to the bladder as it courses through the pelvis. During transurethral operations, resection may result in stimulation of the obturator nerve, causing violent adductor contraction. Bladder perforation and incomplete tumor resection are the most important complications. All techniques proposed since transurethral surgery began, until nowadays are reviewed: neuromuscular blockade, electric circuit modifications, transparietal endoscopic blockade, periprostatic and subvesical infiltration, obturator nerve blockade and the "3 in 1 block" described by Winnie. Practical advices are proposed finally.

Humans↗
PubMed2005

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.

Adjuvants, Anesthesia↗
PubMed1984

[Blockade of the obturator nerve in transurethral electroresection of urinary bladder tumors].

Stimulation of obturator nerve during transurethral electroresection causes violent adductor muscle contraction, and is a major cause of inadvertent bladder perforation. General anesthesia with muscle relaxants is often required when the bladder tumor is in the area where the obturator nerve passes in close proximity to the inferolateral bladder wall. Recently obturator nerve block under spinal anesthesia during transurethral surgery have been reported in several papers, but the blockade is not completely reliable. Obturator nerve block using electrostimulator (neutracer) and insulated electroneedle (pole needle) was performed in 25 patients with bladder tumors during transurethral electroresection from October 1980 to December 1981. We herein describe the technique and results of local obturator nerve blockade. Use of neutracer and pole needle makes the obturator nerve block a completely reliable, safe and easy procedure.

Adult↗
PubMed2006

[Vaginal revision of irritation of the obturator nerve within colposuspension].

Irritation of the obturator-nerve within colposuspension is a possible complication because of topographic proximity between obturator-nerve and operating-field. The main symptoms are weakness of the adductor muscles, sensory disturbance of thigh till paralysis and pain in the operating- field early after surgery. Too lateral fixing of the sutures in the pectineal ligament above the obturator-channel can cause compression of the obturator-nerve. Precocious intervention is a precondition for complete remission of symptoms, retropubic revise of surgery is evident. The method outlined here describes vaginal access for re-surgery with lateral colpotomy and dissection of the proximal colposuspension s suture. In this way a recurrent laparotomy with additional trauma of the operating-field can be avoided. In the case described here, this method led to the patients complete remission.

Adult↗
PubMed1997

Obturator nerve entrapment.

PURPOSE: To describe a case of obturator nerve entrapment, a previously unreported cause of chronic groin pain in athletes. CASE SUMMARY: A 23-year-old man, an elite Australian rules footballer, presented with a 2-year history of groin pain. Conservative treatment was unsuccessful. Examination postexercise revealed adductor weakness and medial thigh paraesthesia. Diagnosis of obturator nerve entrapment was confirmed by EMG and nerve block. Surgical neurolysis was performed. The patient returned to sport and has remained symptom free. DISCUSSION: Although intrapelvic obturator nerve entrapment has been reported following surgical trauma, no cases of sport-related entrapment have been described. RELEVANCE: Obturator nerve entrapment should be considered as a potential cause of chronic groin pain in athletes.

Adult↗
PubMed1995

Electromyographic comparison of obturator nerve block to three-in-one block.

Obturator nerve block during spinal, epidural, or general anesthesia without muscle relaxants has been recommended for transurethral surgery to prevent thigh adductor muscle contractions during operative electrocautery. We investigated the effectiveness of direct obturator and 3-in-1 nerve motor blocks in 44 patients undergoing transurethral surgery during spinal anesthesia with isobaric bupivacaine. Patients were randomly assigned to receive 3-in-1 block with 40 mL (n = 13) or 50 mL (n = 11) of 1.5% lidocaine plus epinephrine, or direct obturator nerve block with 10 mL of 2% lidocaine plus epinephrine (n = 20). After both direct obturator and 3-in-1 blocks, compound muscle action potential (CMAP) testing of the obturator nerve was performed at 1-10-s intervals for 10 min. In patients given direct obturator nerve block (n = 20), CMAP amplitude decreased by 88.8 +/- 21% (mean +/- SD) from baseline. In contrast, 3-in-1 block reduced the evoked CMAP amplitude by 7.4 +/- 19% (P < 0.05). Peak lidocaine plasma levels of 1.6 +/- 0.2 micrograms/mL (range 1.0-2.8 micrograms/mL) were reached 60-90 min after the block in those patients receiving 50 mL of local anesthetic. The 3-in-1 technique fails to predictably result in effective motor block of the obturator nerve and thus may not prevent inadvertent thigh adductor muscle contractions during transurethral surgery. A direct approach to the obturator nerve is significantly more effective in producing motor block, and even when given in larger than recommended dosages it results in subtoxic peak plasma lidocaine concentrations.

Action Potentials↗
PubMed1992

Plasma concentrations of lignocaine after obturator nerve block combined with spinal anaesthesia in patients undergoing transurethral resection procedures.

Bilateral obturator nerve block has become a widely accepted technique to avoid adductor contraction during transurethral resection of prostate or bladder tumours. However, little is known about plasma lignocaine concentrations after the block. We conducted this study to assess a safe dose of lignocaine for injection in obturator nerve block. Bilateral obturator nerve block was performed with the aid of a peripheral nerve stimulator in 12 patients after spinal anaesthesia. In group I (n = 6), patients received 2% lignocaine 10 ml (200 mg) for the block; those in group II (n = 6) received 2% lignocaine 15 ml (300 mg). The block was satisfactory and no single adductor contraction was observed in either group during surgery. The peak plasma concentrations of lignocaine were 2.28 (SD 0.29) micrograms ml-1 and 3.75 (0.79) micrograms ml-1 in groups I and II, respectively. The greatest plasma concentration was 5.07 micrograms ml-1 in a patient of group II. There were no symptoms suggesting systemic toxicity. We conclude that bilateral obturator nerve block may be performed safely and effectively with 2% lignocaine 10 ml with the aid of a peripheral nerve stimulator in patients undergoing transurethral resection procedures with spinal anaesthesia.

Aged↗