Akkaya T, Comert A, Kendir S, Acar H I, Gumus H, Tekdemir I, Elhan A
Department of Anaesthesia and Pain Unit, Ankara Diskapi Training and Research Hospital, Ankara, Turkey.
Minerva Anestesiol. 2008 Apr;74(4):119-22.
The accessory obturator nerve (AON) often innervates the hip joint and adductor longus. The AON is present in 10-30% of patients, and thus it is clinically important that it is also considered during obturator nerve (ON) blockade.
The study was performed on 12 cadavers (24 body-sides) and the AON beginning from the lumbar plexus was observed. The needle was classically penetrated into the ON to gain access to the AON and upon definition of detailed AON anatomy, morphometric measurements were conducted. In addition, novel maneuvers used in the study were described.
Throughout the dissections, the AON was detected on three sides (12.5%) and the mean AON- pubic tubercle distance was measured as 4.0 cm. The needle was withdrawn and positioned medially and almost parallel to the skin. It was then advanced through the superior pubic ramus to reach the AON.
Owing to its anatomical structure, the AON can be easily accessed during classical ON blockade using the maneuvers described here. Further clinical studies are needed to investigate if supplementing ON blockade with AON blockade might improve the clinical efficiency and quality of the blockade.
闭孔副神经（AON）常支配髋关节和长收肌。10% - 30%的患者存在AON，因此在闭孔神经（ON）阻滞时考虑到它在临床上具有重要意义。
对12具尸体（24个身体侧）进行研究，观察从腰丛发出的AON。经典方法是将针穿入ON以接近AON，在明确AON详细解剖结构后进行形态学测量。此外，还描述了本研究中使用的新操作方法。
在整个解剖过程中，在3个侧别（12.5%）检测到AON，AON与耻骨结节的平均距离测量为4.0 cm。将针拔出并向内侧移动，使其几乎与皮肤平行。然后将针推进穿过耻骨上支以到达AON。
由于其解剖结构，使用此处描述的操作方法在经典ON阻滞过程中可轻松接近AON。需要进一步的临床研究来调查用AON阻滞补充ON阻滞是否可能提高阻滞的临床效率和质量。
