Yoshida Takayuki, Nakano Yousuke, Kitada Masaaki, Nakamoto Tatsuo
Department of Anesthesiology, Kansai Medical University Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan.
Department of Anatomy, Faculty of Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
J Anesth. 2024 Dec 2. doi: 10.1007/s00540-024-03434-1.
The obturator nerve variably gives off the anterior, posterior, and hip articular branches along its course; however, all branches invariably pass through the obturator canal. Herein, we describe our obturator nerve block technique, which promises to deliver local anesthetic directly into the obturator canal. We performed the obturator nerve block in six patients undergoing transurethral resection of bladder tumor under spinal anesthesia. We also evaluated the spread of dye in a cadaver. With patient placed in the lithotomy position, a linear ultrasound transducer was placed on the anterior part of the genitofemoral sulcus, oriented cephalad, to observe the external orifice of the obturator canal, which is present immediately posterior to the posterior end of the inferior margin of the superior pubic ramus and just medial to the body of the ischium. The needle tip was guided to this location, and 10 ml of 1.5% lidocaine was injected into the obturator canal. The procedure was repeated using 10-ml dye in a cadaver. No obturator jerks were observed during the transurethral resection of bladder tumors in all six cases. Cadaver examination confirmed the dye stained the obturator nerve, with retrograde spread into the pelvic cavity via the obturator canal.
闭孔神经在其走行过程中可变地发出前支、后支和髋关节支；然而，所有分支均恒定地穿过闭孔管。在此，我们描述我们的闭孔神经阻滞技术，该技术有望将局部麻醉药直接注入闭孔管。我们对6例在脊髓麻醉下行经尿道膀胱肿瘤切除术的患者实施了闭孔神经阻滞。我们还在一具尸体上评估了染料的扩散情况。患者取截石位，将线性超声换能器置于股股沟沟前部，头侧朝向，以观察闭孔管外口，其位于耻骨上支下缘后端后方紧邻处且恰在坐骨体内侧。将针尖引导至该位置，并向闭孔管内注入10毫升1.5%利多卡因。在一具尸体上使用10毫升染料重复该操作。在所有6例经尿道膀胱肿瘤切除术中均未观察到闭孔肌反射。尸体检查证实染料使闭孔神经染色，并通过闭孔管逆行扩散至盆腔。
