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Anesth Analg 2008; 106:664-667
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e3181607205
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Right arrow Regional Anesthesia

REGIONAL ANESTHESIA

Does Sciatic Parasacral Injection Spread to the Obturator Nerve? An Anatomic Study

Nathalie Valade, MD{dagger}, Jacques Ripart, MD, PhD{dagger}, Emmanuel Nouvellon, MD, MSc{dagger}, Philippe Cuvillon, MD, MSc{dagger}, Dominique Prat-Pradal, MD, PhD*, Jean-Yves Lefrant, MD, PhD{dagger}, and Jean-Emmanuel de La Coussaye, MD, PhD{dagger}

From the *Laboratoire d'anatomie, faculté de médecine Montpellier-Nimes, Université Montpellier I, France; and {dagger}Division Anesthésie-Douleur-Urgence-Réanimation, Groupe Hospitalier Universitaire Caremeau, Nimes, France.

BACKGROUND: The ability of parasacral sciatic nerve block to provide consistent obturator nerve and perineal blockade remains undetermined. In this anatomic work, we assessed the spread of a colored latex mimicking a parasacral injection, and observed the spread to the obturator nerve and sacral nerve roots.

METHODS: Fourteen parasacral injections were performed bilaterally on seven human cadavers. Dissection was performed in two steps. First, the posterior approach confirmed the presence of dye on the sciatic nerve at the level of the piriformis muscle to define the success of the injection. Second, the anterior endopelvic dissection assessed the presence of dye around the pelvic portion of the obturator nerve and on the sacral roots (S1–3). The same score was used for all the nerves, from 0 (total failure) to 3 (total success). For all nerves (sciatic, obturator, sacral roots), a score of 2 or 3 was considered a successful injection.

RESULTS: Eleven of 14 injections were considered successful parasacral injections. The three failed injections were excluded from further analysis. One was intravascular and two (same cadaver) in the gluteal muscles were too superficial. Of the 11 successful injections, 9 (82%) were scored as providing the spread of latex to both the obturator nerve and to the sacral roots.

CONCLUSION: We conclude from this anatomical study that successful parasacral injection consistently spreads to the pelvic portion of the obturator nerve and to the sacral roots. Therefore, parasacral block should theoretically provide obturator and perineal blockade, and eliminate the need for systematic separate obturator nerve block. These results must be confirmed by further clinical studies.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.