The Effect of Interfascial Injection on Obturator Nerve Block Compared with Nerve Stimulating Approach by Ultrasound-Guide: A Randomized Clinical Trial
Vol. 16 No. 4 (2019),
18 August 2019
Purpose: This study was conducted to evaluate whether the ultrasound-guided interfascial injection technique is really compatible with the ultrasound-guided nerve stimulating technique for obturator nerve block (ONB) at the inguinal crease after bifurcation of the obturator nerve.
Materials and Methods: A total 62 ONBs were performed for transurethral resection of bladder tumors under spinal anesthesia, and divided into two groups, that is, to an ultrasound-guided ONB with nerve stimulation control group (the US-NS group) or an ultrasound-guided interfascial injection experimental group (the US-IFI group). In the US-IFI group, complete ONB was confirmed using a nerve stimulator at 5 min after completing the injection, and if residual twitching remained, another local anesthetic was injected; in such cases blocks were considered to have ‘failed’. During TURB surgeries, two urology assistants determined obturator reflex grade (I-IV) at 15 min after injection completion in both groups.
Results: We assumed that the US-NS group achieved complete ONB in all cases. Six cases in the US-IFI group failed to achieve complete ONB (failure rate: 0% versus 19.4%, P = .012). There was one case of grade II obturator reflex in each group.
Conclusion: The ultrasound-guided interfascial injection technique was not compatible with the ultrasound-guided nerve stimulating technique for ONB at the inguinal crease.
Ong EL, Chan ST. Transurethral surgery and the adductor spasm. Ann Acad Med Singapore. 2000; 29:259-62.
Moningi S, Durga P, Ramachandran G, Murthy PV, Chilumala RR. Comparison of inguinal versus classic approach for obturator nerve block in patients undergoing transurethral resection of bladder tumors under spinal anesthesia. J Anaesthesiol Clin Pharmacol. 2014; 30:41-5.
Thallaj A, Rabah D. Efficacy of ultrasound-guided obturator nerve block in transurethral surgery. Saudi J Anaesth. 2011; 5:42-4.
Shah NF, Sofi KP, Nengroo SH. Obturator nerve block in transurethral resection of bladder tumor: a comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique. Anesth Essays Res. 2017; 11:411-5.
Helayel PE, da Conceicão DB, Pavei P, Knaesel JA, de Oliveira Filho GR. Ultrasound-guided obturator nerve block: a preliminary report of a case series. Reg Anesth Pain Med. 2007; 32:221-6.
Fujiwara Y, Sato Y, Kitayama M, Shibata Y, Komatsu T, Hirota K. Obturator nerve block using ultrasound guidance. Anesth Analg. 2007; 105:888-9.
Manassero A, Bossolasco M, Uques 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; 37:67-71.
Sinha SK, Abrams JH, Houle TT, Weller RS. Ultrasound-guided obturator nerve block: an interfascial injection approach without nerve stimulation. Reg Anesth Pain Med. 2009; 34:261-4.
Soong J, Schafhalter-Zoppoth I, Gray AT. Sonographic imaging of the obturator nerve for regional block. Reg Anesth Pain Med. 2007; 32:146-51.
Lee SH, Jeong CW, Lee HJ, Yoon MH, Kim WM. Ultrasound guided obturator nerve block: a single interfascial injection technique. J Anesth. 2011; 25:923-6.
Akata T, Murakami J, Yoshinaga A. Life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block. Acta Anaesthesiol Scand. 1999; 43:784-8.
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 technique. Reg Anesth Pain Med. 2009; 34:33-9.
Saranteas T, Paraskeuopoulos T, Alevizou A, et al. Identification of the obturator nerve divisions and subdivisions in the inguinal region: a study with ultrasound. Acta Anaesthesiol Scand. 2007; 51:1404-6.
- Abstract Viewed: 682 times
- PDF/4386 Downloaded: 284 times