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Obturator Nerve Block
Colin J. McCarthy, MB, BCh, BAO, MRCSI, FFR (RCSI); Rafael Vazquez, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Obturator nerve (ON)
              • Obturator nerve block (ONB)
            • Definitions

              • Blockade of ON
                • Arises from anterior rami of L2-L4 nerve roots from lumbar plexus within psoas major muscle
                • Emerges from psoas major medial into pelvis and then along obturator canal (accompanied by vessels) to reach medial thigh compartment
                • ± concomitant block of additional nerves (e.g., femoral, sciatic &/or posterior lumbar plexus)
                • In proximal medial thigh, it divides into anterior and posterior division and supplies adductor muscles
                  • Anterior division travels between adductor longus and adductor brevis muscles
                  • Posterior division travels between adductor brevis and adductor magnus muscles
                • Responsible innervation to hip joint at inferior femoral neck, pubic ramus, medial femoral shaft, and its medial condyle
                • Sensory innervation to midinner thigh and posterior knee joint
              • Renders anesthesia for 6-12 hours
              • Steroids can be added to anesthetic solution in cases where component of entrapment or inflammation is suspected
              • Provides somatic pain coverage

            PREPROCEDURE

            • Indications

              • Contraindications

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things to Do

                                • Things to Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      Selected References

                                      1. Nielsen ND et al: An obturator nerve block does not alleviate postoperative pain after total hip arthroplasty: a randomized clinical trial. Reg Anesth Pain Med. ePub, 2019
                                      2. Tran DQ et al: Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med. ePub, 2019
                                      3. Bareka M et al: Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery. Knee Surg Sports Traumatol Arthrosc. 26(2):478-84, 2018
                                      4. House CV et al: CT-guided obturator nerve block via the posterior approach. Skeletal Radiol. 35(4):227-32, 2006
                                      5. Choquet O et al: A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies. Anesthesiology. 103(6):1238-45, 2005
                                      6. Heywang-Köbrunner SH et al: CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip. Eur Radiol. 11(6):1047-53, 2001
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Procedure

                                            • Post Procedure

                                              • Outcomes

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Obturator nerve (ON)
                                                  • Obturator nerve block (ONB)
                                                • Definitions

                                                  • Blockade of ON
                                                    • Arises from anterior rami of L2-L4 nerve roots from lumbar plexus within psoas major muscle
                                                    • Emerges from psoas major medial into pelvis and then along obturator canal (accompanied by vessels) to reach medial thigh compartment
                                                    • ± concomitant block of additional nerves (e.g., femoral, sciatic &/or posterior lumbar plexus)
                                                    • In proximal medial thigh, it divides into anterior and posterior division and supplies adductor muscles
                                                      • Anterior division travels between adductor longus and adductor brevis muscles
                                                      • Posterior division travels between adductor brevis and adductor magnus muscles
                                                    • Responsible innervation to hip joint at inferior femoral neck, pubic ramus, medial femoral shaft, and its medial condyle
                                                    • Sensory innervation to midinner thigh and posterior knee joint
                                                  • Renders anesthesia for 6-12 hours
                                                  • Steroids can be added to anesthetic solution in cases where component of entrapment or inflammation is suspected
                                                  • Provides somatic pain coverage

                                                PREPROCEDURE

                                                • Indications

                                                  • Contraindications

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Expected Outcome

                                                                  • Things to Do

                                                                    • Things to Avoid

                                                                      OUTCOMES

                                                                      • Problems

                                                                        • Complications

                                                                          Selected References

                                                                          1. Nielsen ND et al: An obturator nerve block does not alleviate postoperative pain after total hip arthroplasty: a randomized clinical trial. Reg Anesth Pain Med. ePub, 2019
                                                                          2. Tran DQ et al: Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med. ePub, 2019
                                                                          3. Bareka M et al: Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery. Knee Surg Sports Traumatol Arthrosc. 26(2):478-84, 2018
                                                                          4. House CV et al: CT-guided obturator nerve block via the posterior approach. Skeletal Radiol. 35(4):227-32, 2006
                                                                          5. Choquet O et al: A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies. Anesthesiology. 103(6):1238-45, 2005
                                                                          6. Heywang-Köbrunner SH et al: CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip. Eur Radiol. 11(6):1047-53, 2001