ORIGINAL ARTICLE
Can different positions facilitate block application in ultrasound-guided obturator nerve block? A prospective comparative study
More details
Hide details
1
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, TURKEY
2
Department of Anatomy, Faculty of Medicine, Harran University, Sanliurfa, TURKEY
Online publication date: 2023-11-01
Publication date: 2023-01-01
Electron J Gen Med 2023;20(1):em426
KEYWORDS
ABSTRACT
Objective:
We aimed to compare the distances of the landmarks to the skin, image quality, and ease of application in the ultrasound-guided obturator nerve block (ONB) in different positions.
Material and Methods:
40 volunteers aged between 20-65 years were included in the study. The distances of the landmarks (anterior and posterior branches of the obturator nerve; junction of the abductor longus and abductor brevis muscles with the pectineus muscle) to the skin, which were taken as a reference for the ultrasound-guided obturator block, were measured and compared in 3 different positions (P1=Neutral position; P2=45o Abduction; and P3=Flexed knee) given to the leg. We also evaluated the quality of the ultrasound image and the ease of application in each measurement by assigning a subjective observer score and comparisons were made for three positions.
Results:
While the mean of the distances of the landmarks to the skin were the shortest in P3 and the longest in P1 position, there was no significant difference between the groups (p>0.05). A statistically significant difference was observed between P1 and P3 in the distance of the junction of the muscles to the skin surface (p<0.05). The highest score for the clarity of ultrasound images and ease of accessing the measurement points was the P3 position (p=0.00). In addition, in our correlation analysis, we found that as the distance of the landmarks to the skin surface decreased, the image clarity and the ease of access to the obturator nerve (score) increased, where p<0.05.
Conclusions:
In ultrasound guided ONB, in P3 position landmarks get closer to the skin, and image clarity and ease of detection for landmarks increases in parallel with this position. As a result, the ultrasound guided ONB can be best done by giving flexed knee position.
REFERENCES (18)
1.
Manassero A, Bossolasco M, Ugues S, Palmisano S, De Bonis U, Coletta G. Ultrasound-guided obturator nerve block: Interfascial injection versus a neurostimulation-assisted technique. Reg Anesth Pain Med. 2012;37(1):67-71.
https://doi.org/10.1097/AAP.0b... PMid:22157744.
2.
Jo SY, Chang JC, Bae HG, Oh JS, Heo J, Hwang JC. A morphometric study of the obturator nerve around the obturator foramen. J Korean Neurosurg Soc. 2016;59(3):282-6.
https://doi.org/10.3340/jkns.2... PMid:27226861 PMCid:PMC4877552.
3.
Anagnostopoulou S, Kostopanagiotou G, Paraskeuopoulos T, Chantzi C, Lolis E, Saranteas T. Anatomic variations of the obturator nerve in the inguinal region: Implications in conventional and ultrasound regional anesthesia techniques. Reg Anesth Pain Med. 2009;34(1):33-9.
https://doi.org/10.1097/AAP.0b... PMid:19258986.
5.
Bouaziz H, Vial F, Jochum D, et al. An evaluation of the cutaneous distribution after obturator nerve block. Anesth Analg. 2002;94(2):445-9.
https://doi.org/10.1213/000005... PMid:11812716.
6.
Akkaya T, Comert A, Kendir S, et al. Detailed anatomy of accessory obturator nerve blockade. Minerva Anestesiol. 2008;74(4):119-22.
7.
Sharma D, Singh VP, Agarwal N, Malhotra MK. Obturator nerve block in transurethral resection of bladder tumor: A comparative study by two techniques. Anesth Essays Res. 2017;11(1):101-4.
https://doi.org/10.4103/0259-1... PMid:28298765 PMCid:PMC5341669.
8.
Yoshida T, Nakamoto T, Kamibayashi T. Ultrasound-guided obturator nerve block: A focused review on anatomy and updated techniques. Biomed Res Int. 2017;2017:7023750.
https://doi.org/10.1155/2017/7... PMid:28280738 PMCid:PMC5322453.
9.
Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of moratality in 578 patients. Br J Anaesth. 1986;58(3):284-91.
https://doi.org/10.1093/bja/58... PMid:3947489.
10.
Vorobeichik L, Brull R, Bowry R, Laffey JG, Abdallah FW. Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effects profiles. Br J Anaesth. 2018;120(4):679-92.
https://doi.org/10.1016/j.bja.... PMid:29576109.
11.
Gianesello L, Pavoni V, Burzio I, Boccaccini A. Respiratory effect of interscalene brachial plexus block vs combined infraclavicular plexus block with suprascapular nerve block for arthroscopic shoulder surgery. J Clin Anesth. 2018;44:117-8.
https://doi.org/10.1016/j.jcli... PMid:29195098.
12.
Gadsden JC. The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia. Anaesthesia. 2021;76:65-73.
https://doi.org/10.1111/anae.1... PMid:33426665.
13.
Labat G. Regional anesthesia; its technic and clinical application. WB Saunders; 1922.
14.
Prentiss RJ, Harvey GW, Bethard WF, Boatwright DE, Pennington RD. Massive adductor muscle contraction in transurethral surgery: Cause and prevention; development of new electrical circuitry. J Urol. 1965;93(2):263-71.
https://doi.org/10.1016/S0022-....
15.
Wassef MR. Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles. Reg Anesth Pain Med. 1993;18(1):13-7.
16.
Akkaya T, Ozturk E, Comert A, et al. Ultrasound-guided obturator nerve block: A sonoanatomic study of a new methodologic approach. Anesth Analg. 2009;108(3):1037-41.
https://doi.org/10.1213/ane.0b... PMid:19224822.
17.
Soong J, Schafhalter-Zoppoth I, Gray AT. Sonographic imaging of the obturator nerve for regional block. Reg Anesth Pain Med. 2007;32(2):146-51.
https://doi.org/10.1097/001155... PMid:17350526.
18.
Taha AM. Brief reports: Ultrasound-guided obturator nerve block: A proximal interfascial technique. Anesth Analg. 2012;114(1):236-9.
https://doi.org/10.1213/ANE.0b... PMid:22025494.