Yoshida Takayuki, Nakamoto Tatsuo, Kamibayashi Takahiko
Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata City, Osaka, Japan.
Biomed Res Int. 2017;2017:7023750. doi: 10.1155/2017/7023750. Epub 2017 Feb 9.
This review outlines the anatomy of the obturator nerve and the indications for obturator nerve block (ONB). Ultrasound-guided ONB techniques and unresolved issues regarding these procedures are also discussed. An ONB is performed to prevent thigh adductor jerk during transurethral resection of bladder tumor, provide analgesia for knee surgery, treat hip pain, and improve persistent hip adductor spasticity. Various ultrasound-guided ONB techniques can be used and can be classified according to whether the approach is distal or proximal. In the distal approach, a transducer is placed at the inguinal crease; the anterior and posterior branches of the nerve are then blocked by two injections of local anesthetic directed toward the interfascial planes where each branch lies. The proximal approach comprises a single injection of local anesthetic into the interfascial plane between the pectineus and obturator externus muscles. Several proximal approaches involving different patient and transducer positions are reported. The proximal approach may be superior for reducing the dose of local anesthetic and providing successful blockade of the obturator nerve, including the hip articular branch, when compared with the distal approach. This hypothesis and any differences between the proximal ONB techniques need to be explored in future studies.
本综述概述了闭孔神经的解剖结构以及闭孔神经阻滞（ONB）的适应证。还讨论了超声引导下的ONB技术以及这些操作中尚未解决的问题。进行ONB可预防经尿道膀胱肿瘤切除术中大腿内收肌抽搐，为膝关节手术提供镇痛，治疗髋部疼痛，并改善持续性髋部内收肌痉挛。可使用多种超声引导下的ONB技术，可根据进针部位是远端还是近端进行分类。在远端进针方法中，将换能器置于腹股沟皱襞处；然后通过向神经各分支所在的筋膜间隙平面注射两次局部麻醉剂来阻滞神经的前支和后支。近端进针方法包括向耻骨肌和闭孔外肌之间的筋膜间隙平面单次注射局部麻醉剂。报道了几种涉及不同患者和换能器位置的近端进针方法。与远端进针方法相比，近端进针方法在减少局部麻醉剂剂量以及成功阻滞闭孔神经（包括髋关节支）方面可能更具优势。这一假设以及近端ONB技术之间的任何差异需要在未来的研究中进行探索。
