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REGIONAL ANESTHESIA

Adding a Selective Obturator Nerve Block to the Parasacral Sciatic Nerve Block: An Evaluation

Denis Jochum, MD^*, Gabriella Iohom, FCARCSI, Olivier Choquet, MD, Dioukamady Macalou, MD, Samba Ouologuem, MD, Pascal Meuret, MD, Freddy Kayembe, MD, Michel Heck, MD, Paul-Michel Mertes, MD PhD, and Hervé Bouaziz, MD PhD

*Department of Anesthesiology and Intensive Care Medicine, Private Hospital Group of Center Alsace, Colmar, France; Department of Anesthesiology and Intensive Care Medicine, Nancy University Hospitals, Nancy, France; Department of Anesthesiology, Hôpital de la Conception, Marseille, France

Address correspondence and reprint requests to Professor Hervé Bouaziz Service d’anesthésie-réanimation chirurgicale Hôpitaux de ville, CHU de Nancy 29, Avenue du Maréchal-de-Lattre-de-Tassigny 54035 Nancy Cedex, France. Address e-mail to h.bouaziz{at}chu-nancy.fr

Our aim was to objectively evaluate the efficacy of obturator nerve anesthesia after a parasacral block. Patients scheduled for knee surgery had a baseline adductor strength evaluation. After a parasacral block with 30 mL 0.75% ropivacaine, sensory deficit in the sciatic distribution (temperature discrimination) and adductor strength were assessed at 5-min intervals. Patients with an incomplete sensory block (defined as a temperature discrimination score of less than 2 in the 3 cutaneous distributions of the sciatic nerve tested) 30 min after the parasacral block were excluded from the study. Subsequently, a selective obturator block was performed with 7 mL 0.75% ropivacaine and adductor strength was reassessed at 5 min intervals for 15 min. Finally, a femoral block was performed using 10 mL 0.75% ropivacaine. Patient discomfort level during each block was assessed using a visual analog scale (VAS). Thirty-one patients completed the study. Five patients were excluded as a result of inadequate sensory block in the sciatic distribution 30 min after the parasacral block (success rate of 89%). Thirty min after the parasacral block, adductor strength decreased by 11.3% ± 7% compared with baseline (85 ± 24 versus 97 ± 28 mm Hg, P = 0.002). Fifteen min after the obturator nerve block, adductor muscle strength decreased by an additional 69% ± 7% (16.6 ± 15 versus 85 ± 24 mm Hg, P < 0.0001). VAS scores were similar for all blocks (26 ± 19, 28 ± 24, and 27 ± 19 mm for parasacral, obturator, and femoral respectively). Four parasacral blocks were simulated in 2 fresh cadavers using 30 mL of colored latex solution. The spread of the die in relation to the obturator nerve was assessed. Injection of 30 mL colored latex into cadavers resulted in spread of the injectate restricted to the sacral plexus. These findings demonstrate the unreliability of parasacral block to achieve anesthesia of the obturator nerve. A selective obturator block should be considered in the clinical setting when this is desirable.

IMPLICATIONS: The aim of this study was to objectively evaluate the efficacy of obturator nerve anesthesia after a parasacral block. These findings demonstrate the unreliability of parasacral block to achieve obturator nerve anesthesia. A selective obturator nerve block should be considered in the clinical setting when such a block is desirable.

This article has been cited by other articles:

				N. Valade, J. Ripart, E. Nouvellon, P. Cuvillon, D. Prat-Pradal, J.-Y. Lefrant, and J.-E. de La Coussaye Does Sciatic Parasacral Injection Spread to the Obturator Nerve? An Anatomic Study Anesth. Analg., February 1, 2008; 106(2): 664 - 667. [Abstract] [Full Text] [PDF]

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