Obturator nerve block

The obturator nerve block ( obturator nerve block ) is a peripheral regional anesthetic procedure in which the obturator nerve is reversibly blocked by injecting local anesthetics in the area of ​​the groin . The obturator block is a relatively easy to carry out procedure with few side effects, the most important indication of which is transurethral resection of the bladder .

application areas

The main area of ​​application is urological interventions on the bladder, in which tissue is removed from the side wall of the bladder by means of electrocautery through the urethra (transurethral) . Since the obturator nerve runs directly outside the bladder wall, it is possible to trigger reflex-like contractions of the adductor muscles on the leg, which are then motorized by it. This allows the resectoscope to perforate the bladder.

Further indications are the addition of an incomplete " 3-in-1 block ", pain syndromes in the hip joint (sensitive branches of the anterior ramus) and adductor spasm conditions, in which a pain catheter can also be inserted for continuous pain therapy.

Contraindications (contraindications) are infections or tumors in the puncture area as well as rejection or lack of cooperation by the patient. Disorders of blood coagulation or taking anticoagulant drugs, vascular prostheses in the groin area and nerve damage represent relative contraindications.

execution

The patient is supine with the leg slightly abducted on the corresponding side. The identification of the nerve in the groin region can be carried out in various ways. Often the search is carried out with the help of a nerve stimulator that is connected to the end of the puncture cannula. The puncture is performed in the orthogonal direction lateral to the adductor muscle attachment on the pubic bone . An alternative method of puncture points the needle at a 45 ° angle in the direction of the anterior superior iliac spine . The position of the tip of the needle near the nerve is shown by muscle twitching of the adductor group on the thigh. Also, ultrasound-guided puncture is possible. If the position is correct, 10–20 ml of local anesthetic ( prilocaine , mepivacaine , ropivacaine ) are injected.

Side effects

Overall, side effects with obturator nerve block are rare. The complications correspond to the general side effects of peripheral regional anesthesia. Nerve damage can be caused by direct cannula injury or by toxic effects of local anesthetics that are accidentally injected into the nerves (intraneurally). This damage can be avoided by using blunt cannulas and avoiding injections in case of paresthesia during the procedure. Puncturing a vessel can result in a bruise ( hematoma ). Accidental injection into blood vessels (intravascularly) can have effects on the cardiovascular system ( bradycardia , hypotension , cardiac arrest at high doses) or the central nervous system ( seizures , impaired consciousness ).

literature

• Meier, Büttner: Compendium of peripheral blockages. Arcis Publishing House; 6th edition 2008. ISBN 978-3890751771
• Rossaint, Werner, Zwissler (ed.): The anesthesiology. General and special anesthesiology, pain therapy and intensive care medicine. Springer, Berlin; 2nd edition 2008. ISBN 978-3540763017

Web links

• Performing the obturator blockade at www.nerveblocks.net

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !