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Does obturator nerve block always occur in 3-1 block?

Year 2011, Volume: 2 Issue: 2, 149 - 151, 01.06.2011
https://doi.org/10.5799/ahinjs.01.2011.02.0229

Abstract

Objective: In the femoral "3-in-1 block", obturator nerve block is routinely unsuccessful. Anatomical studies are not available to explain why blockade of obturator nerve or lumbar plexus does not occur. The aim of this study was to examine the effectiveness of femoral "3-in-1 block" obturator nerve block on a cadaver model. Materials and methods: Totally, 12 mature adult human cadavers were selected. Methylene blue dye (30 ml) was in-jected under the fascia iliaca in eight cadavers and into the femoral nerve sheath in four cadavers. Careful bilateral dissections were performed following dye injections. Results: It was seen that the dye did not spread to the medial part of the psoas major muscle and the obturator nerve was not stained with the dye in eight cadavers in whom dye was injected laterally into the femoral sheat. In four ca-davers in whom dye was injected into the femoral nerve sheat, metylene blue spread through fascial layers in the plane under the psoas muscle and stained the obturator nerve just before emerging medially from the fascia psoas. At this point, the obturator nerve pierced the psoas fascia and extended extrafascially in the medial and deep borders of the psoas muscle. In this area, the upper section of the obturator nerve was found also to be stained with the dye. Conclusion: We concluded that the cause of an unsuccessful obturator nerve block might be the fascial anatomy of this region. The lateral cutaneous femoral nerve and the femoral nerve easily can be blocked in the fascia iliaca com-partment, but the obturator nerve block fails because of its being extrafascial in this region.

References

  • Winnie AP, Ramamurthy S, Durrani Z. The inguinal para- vascular technic of lumbar plexus anesthesia: the “3-in-1 block”. Anesth Analg 1973;52(8):989-96.
  • Ritter JW. Femoral nerve “sheath” for inguinal paravascular lumbar plexus block is not found in human cadavers. J Clin Anesth 1995;7(4):470-3.
  • Lonsdale M. 3-in-1block: confimation of Winnie’s anatomi- cal hypothesis. Anesth Analg 1988;67(5):601-2.
  • Cauhepe C, et al. The “3-in-1” block: myth or reality? Ann Fr Anesth Réanim 1989;8(3):376-8.
  • Gardner E, Bunge R. Gross anatomy of the perpheral nervous system. In: Dyck P, Thomas P (eds): Peripheral Neuropathy, 3rd ed. Philadelphia: W.B. Saunders Co., 1993:21-2.
  • Thomas P, et al. Microscopic anatomy of the peripheral ner- vous system. In: Dyck P, Thomas P (eds): Peripheral Neu- ropthy, 3rd ed. Philadelphia: W.B. Saunders Co., 1993:21.
  • Pick TP, Howden R. Muscles and fasciae of the lower ex- tremity. In: Pick TP, Howden R, eds. Gray’s Anatomy: The Classic Collector’s Edition. New York, Crown, 1977:416.
  • Williams PL, Warick R, Dyson M, Bannister LH. Gray’s anat- omy. 37th ed. London: Churchill Livingstone, 1989:371-3.
  • Spillane WF. 3-in-1 blocks and continuous 3-in-1 blocks. Reg Anesth 1992;17(2):175-6.
  • Parkinson SK, Mueller JB, Little WL, et al. Extend of blokade with various approaches to the lumbar plexus. Anesth Analg 1989;68(4):243-8.
  • Rosenblatt RM. Continuous femoral anesthesia for lower extremiy surgery. Anesth Analg 1980;59(6):631-2.
  • Lang SA, Yip RW, et al. The femoral block revisited. J Clin Anesth 1993;5(4):292-6.
  • Dupré LJ. “Three-in-one” block or femoral nerve block. How and when to do it? Ann Fr Anesth Réanim 1996;15(8):1099- 106.

Obturator sinir 3-1 blok ile her zaman bloke olur mu?

Year 2011, Volume: 2 Issue: 2, 149 - 151, 01.06.2011
https://doi.org/10.5799/ahinjs.01.2011.02.0229

Abstract

Amaç: Femoral "3-1 blok" uygulamalarında obturator sinir bloğu genellikle başarısız olmaktadır. Obturator sinir veya lomber pleksus bloğunun niçin oluşmadığını açıklayıcı yeterli sayıda anatomi çalışması bulunmamaktadır. Bu çalışma-nın amacı, femoral 3-1 obturator sinir bloku etkinliğini bir kadavra modeli üzerinde incelemektir. Gereç ve yöntem: Toplam 12 erişkin insan kadavrası seçildi. Sekiz kadavraya 30 ml metilen mavisi iliak fasiya altına ve dört kadavraya da femoral sinir kılıfı içerisine enjekte edildi. Daha sonra dikkatli bilateral disseksiyon yapıldı. Bulgular: Femoral kılıfın lateraline metilen mavisi enjekte edilen sekiz kadavrada metilen mavisinin psoas major kasın medialine yayılmadığı ve obturator sinire ulaşmadığı görüldü. Femoral sinir kılıfı içine metilen mavisi enjekte edilen dört kadavrada ise metilen mavisinin psoas kasının altından fasialar arasında yayıldığı ve obturator siniri boyadığı görüldü. Bu noktada obturator sinir psoas fasiyasını delerek ekstrafasiyal olarak psoas kasının orta ve derin kenarında ilerlemek-tedir. Bu alanda obturator sinirin üst bölümü de boyandı. Sonuç: Sonuç olarak başarısız obturator sinir bloğunun buradaki fasiya anatomisine bağlı olarak gelişiyor olabilir. Fe-moral ve lateral femoral kutanöz sinir subfasiyaldir ve bu iki sinir fasiya iliaka alanında kolaylıkla bloke olmaktadır, an-cak obturator sinir bu bölgede ekstrafasiyal alanda bulunduğu için bloke olmamaktadır.

References

  • Winnie AP, Ramamurthy S, Durrani Z. The inguinal para- vascular technic of lumbar plexus anesthesia: the “3-in-1 block”. Anesth Analg 1973;52(8):989-96.
  • Ritter JW. Femoral nerve “sheath” for inguinal paravascular lumbar plexus block is not found in human cadavers. J Clin Anesth 1995;7(4):470-3.
  • Lonsdale M. 3-in-1block: confimation of Winnie’s anatomi- cal hypothesis. Anesth Analg 1988;67(5):601-2.
  • Cauhepe C, et al. The “3-in-1” block: myth or reality? Ann Fr Anesth Réanim 1989;8(3):376-8.
  • Gardner E, Bunge R. Gross anatomy of the perpheral nervous system. In: Dyck P, Thomas P (eds): Peripheral Neuropathy, 3rd ed. Philadelphia: W.B. Saunders Co., 1993:21-2.
  • Thomas P, et al. Microscopic anatomy of the peripheral ner- vous system. In: Dyck P, Thomas P (eds): Peripheral Neu- ropthy, 3rd ed. Philadelphia: W.B. Saunders Co., 1993:21.
  • Pick TP, Howden R. Muscles and fasciae of the lower ex- tremity. In: Pick TP, Howden R, eds. Gray’s Anatomy: The Classic Collector’s Edition. New York, Crown, 1977:416.
  • Williams PL, Warick R, Dyson M, Bannister LH. Gray’s anat- omy. 37th ed. London: Churchill Livingstone, 1989:371-3.
  • Spillane WF. 3-in-1 blocks and continuous 3-in-1 blocks. Reg Anesth 1992;17(2):175-6.
  • Parkinson SK, Mueller JB, Little WL, et al. Extend of blokade with various approaches to the lumbar plexus. Anesth Analg 1989;68(4):243-8.
  • Rosenblatt RM. Continuous femoral anesthesia for lower extremiy surgery. Anesth Analg 1980;59(6):631-2.
  • Lang SA, Yip RW, et al. The femoral block revisited. J Clin Anesth 1993;5(4):292-6.
  • Dupré LJ. “Three-in-one” block or femoral nerve block. How and when to do it? Ann Fr Anesth Réanim 1996;15(8):1099- 106.
There are 13 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Pakize Kirdemir This is me

Ayhan Comert This is me

Simel Kendir This is me

İbrahim Tekdemir This is me

Alaittin Elhan This is me

Publication Date June 1, 2011
Published in Issue Year 2011 Volume: 2 Issue: 2

Cite

APA Kirdemir, P., Comert, A., Kendir, S., Tekdemir, İ., et al. (2011). Obturator sinir 3-1 blok ile her zaman bloke olur mu?. Journal of Clinical and Experimental Investigations, 2(2), 149-151. https://doi.org/10.5799/ahinjs.01.2011.02.0229
AMA Kirdemir P, Comert A, Kendir S, Tekdemir İ, Elhan A. Obturator sinir 3-1 blok ile her zaman bloke olur mu?. J Clin Exp Invest. June 2011;2(2):149-151. doi:10.5799/ahinjs.01.2011.02.0229
Chicago Kirdemir, Pakize, Ayhan Comert, Simel Kendir, İbrahim Tekdemir, and Alaittin Elhan. “Obturator Sinir 3-1 Blok Ile Her Zaman Bloke Olur Mu?”. Journal of Clinical and Experimental Investigations 2, no. 2 (June 2011): 149-51. https://doi.org/10.5799/ahinjs.01.2011.02.0229.
EndNote Kirdemir P, Comert A, Kendir S, Tekdemir İ, Elhan A (June 1, 2011) Obturator sinir 3-1 blok ile her zaman bloke olur mu?. Journal of Clinical and Experimental Investigations 2 2 149–151.
IEEE P. Kirdemir, A. Comert, S. Kendir, İ. Tekdemir, and A. Elhan, “Obturator sinir 3-1 blok ile her zaman bloke olur mu?”, J Clin Exp Invest, vol. 2, no. 2, pp. 149–151, 2011, doi: 10.5799/ahinjs.01.2011.02.0229.
ISNAD Kirdemir, Pakize et al. “Obturator Sinir 3-1 Blok Ile Her Zaman Bloke Olur Mu?”. Journal of Clinical and Experimental Investigations 2/2 (June 2011), 149-151. https://doi.org/10.5799/ahinjs.01.2011.02.0229.
JAMA Kirdemir P, Comert A, Kendir S, Tekdemir İ, Elhan A. Obturator sinir 3-1 blok ile her zaman bloke olur mu?. J Clin Exp Invest. 2011;2:149–151.
MLA Kirdemir, Pakize et al. “Obturator Sinir 3-1 Blok Ile Her Zaman Bloke Olur Mu?”. Journal of Clinical and Experimental Investigations, vol. 2, no. 2, 2011, pp. 149-51, doi:10.5799/ahinjs.01.2011.02.0229.
Vancouver Kirdemir P, Comert A, Kendir S, Tekdemir İ, Elhan A. Obturator sinir 3-1 blok ile her zaman bloke olur mu?. J Clin Exp Invest. 2011;2(2):149-51.