Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Obturator Nerve Injection

From WikiSM

Other Names

  • Obturator Nerve Injection
  • Obturator Nerve Block

Background

The course of the obturator nerve[1]

Key Points

  • Transducer: high frequency, linear
  • Needle: 22 gauge, 3.5 inch
  • Avoid intraneural or intravascular injection

Anatomy of the Obturator Nerve

Palpation Guidance vs Ultrasound Guidance

  • It is strongly encouraged that this block be performed under ultrasound guidance
  • This procedure can not be safely performed with palpation guidance

Indications

Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

Transducer and needle position for short axis in plane approach[2]
The anterior branch (ant. br.) of the obturator nerve (ObN) is seen between the adductor longus muscle (ALM) and the adductor brevis muscle (ABM), whereas the posterior branch (post. br.) is seen between the ABM and the adductor magnus muscle (AMM)[3]

Equipment

  • Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
  • Gloves
  • Needle: typically 22-25 gauge, 3.5 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid
  • Sterile probe cover

Ultrasound Findings

  • Best visualized with high frequency linear transducer
  • There may be pain with sonopalpation
  • Muscle or tendon injuries can be visualized

Technique: Short axis, In plane

  • Patient Position
    • Supine
    • Hip and knee flexed slightly, leg externally rotated
  • Transducer position
    • Short axis to nerve
    • Medial to femoral triangle
  • Needle Approach/ Orientation
    • In plane
    • Lateral to medial
  • Target
    • Obturator nerve perineurium
  • Pearls and Pitfalls
    • Avoid obturator artery
    • Can injection anterior, posterior or both branches

Aftercare

  • Can augment with ice, NSAIDS

Complications

  • Skin: Subcutaneous fat atrophy, skin atrophy, skin depigmentation
  • Painful local reaction
  • Infection
  • Hyperglycemia
  • Tendon, nerve or blood vessel injury

See Also

References

  1. ↑ Craig, Anita. "Nerve compression/entrapment sites of the lower limb." Nerves and nerve injuries. Academic Press, 2015. 755-770.
  2. ↑ Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014)
  3. ↑ Hadzic A: Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, 2nd ed. New York: McGraw-Hill, Inc.; 2011
Created by:
John Kiel on 24 October 2024 18:27:47
Authors:
Last edited:
16 October 2025 01:07:20
Category:
Retrieved from "https://wikism.org/w/index.php?title=Obturator_Nerve_Injection&oldid=37724"