The obturator nerve is derived from the posterior branches of L2-L4 nerves. This nerve enters the thigh through the obturator canal along with the obturator vessels and then divides into anterior and posterior branches. The anterior branch of the obturator provides sensory innervation to the hip joint, a cutaneous branch to the medial aspect of the distal thigh, and motor branches to the superficial hip adductors. The posterior branch gives off an articular branch to the posterior knee joint and motor innervation to the deep hip adductors.
Arrange sterile towels, sterile gloves, gauze pads, marking pen, antiseptic solution, peripheral nerve stimulator, syringes, and needles for local infiltration and nerve block placement.
20-40 ml syringes of local anesthetic. Needles
25 g 1.5 in. needle for skin infiltration and 22 g 3 in. short bevel insulated stimulation needle.
3% chloroprocaine, 2% lidocaine, 0.5% ropivacaine, 0.5% bupivacaine. Surface Anatomy and Landmarks
Landmarks include femoral crease, femoral artery, inguinal ligament, and pubic tubercle. In performance of this block, a 22 g 3 in. needle is inserted perpendicular to the skin 1 in. lateral and 1 in. inferior to the pubic tubercle until the superior pubic ramus is identified/contacted. The needle is then directed inferiorly and laterally about 0.75-1 in. deeper to place the needle in the obturator canal. After negative aspiration a total of 10-15 cc of local is slowly injected.
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