CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip

Heywang‐Köbrunner, Sylvia H.; Amaya, B.; Okoniewski, Matthias; Pickuth, Dirk; Spielmann, Rolf-Peter

doi:10.1007/s003300000682

Cited by 64 publications

(31 citation statements)

References 4 publications

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“…We consider CT guidance with or without external laser marker systems essential for the effectiveness and safety of interventional procedures, especially in complicated structures such as the SIJ, the spine, the hip joint, or for sympathectomies and diagnostic biopsies [19,20,21,22]. Additional safety is achieved by the close communication with the nonsedated patient during the treatment.…”

Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

et al. 2002

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Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks.

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Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

et al. 2002

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“…Other trials have previously investigated the effect of an ONB on other painful conditions in the hip joint: ONB guided by CT provided pain relief in 11 of 15 patients with osteoarthrosis, femoral head necrosis, developmental dysplasia, as well as pain following hip arthroplasty in a prospective observational study 20. Another retrospective observational study found pain relief in patients with chronic hip pain after nerve blocks of the articular branches of both the obturator and the femoral nerves.…”

Section: Discussionmentioning

confidence: 99%

An Obturator Nerve Block does not Alleviate Postoperative Pain after Total Hip Arthroplasty: a Randomized Clinical Trial

Nielsen

Runge

Clemmesen

et al. 2019

Reg Anesth Pain Med

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Background and objectivesA substantial group of patients suffer from moderate to severe pain following elective total hip arthroplasty (THA). Due to the complex innervation of the hip, peripheral nerve block techniques can be challenging and are not widely used. Since the obturator nerve innervates both the anteromedial part of the joint capsule as well as intra-articular nociceptors, we hypothesized that an obturator nerve block (ONB) would decrease the opioid consumption after THA.MethodsSixty-two patients were randomized to receive ONB or placebo (PCB) after primary THA in spinal anesthesia. Primary outcome measure was opioid consumption during the first 12 postoperative hours. Secondary outcome measures included postoperative pain score, nausea score and ability to ambulate.ResultsSixty patients were included in the analysis. Mean (SD) opioid consumption during the first 12 postoperative hours was 39.9 (22.3) mg peroral morphine equivalents (PME) in the ONB group and 40.5 (30.5) mg PME in the PCB group (p=0.93). No difference in level of pain or nausea was found between the groups. Paralysis of the hip adductor muscles in the ONB group reduced the control of the operated lower extremity compared with the PCB group (p=0.026). This did, however, not affect the subjects’ ability to ambulate.ConclusionsA significant reduction in postoperative opioid consumption was not found for active versus PCB ONB after THA.Trial registration number NCT03064165 and 2017-000068-14.

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“…Heywang-Köbrunner et al performed CT-guided obturator nerve blockage for 15 patients with hip pain and cited that this method might be used for diagnosis and treatment for patient with hip pain (26). House et al performed CT-guided obturator blockage technique by using posterior approach for 51 patients.…”

Section: Prevention Of Obturator Reflexesmentioning

confidence: 99%

A nightmare during endoscopic bladder tumor resection; obturator reflex

Kati¹,

İzgi²

2017

J Turgut Ozal Med Cent

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Bladder Tumor is the most common cancer type among urologic cancers and causes high mortality-morbidity if it is not treated early and appropriately. Although there are lots of causes and risks of bladder tumor and it is known that tobacco smoking is the main contributor to bladder tumor, etiology of tumor is not clear. At diagnosis, it is generally seen as a superficial tumor. Transurethral resection of bladder cancer (TUR-B) is the primary surgical method for the diagnosis, staging and treatment of primary or recurrent non-muscle-invasive bladder cancer. In this procedure, different complications may occur, especially bleeding, and the most important complication is bladder perforation. Additional therapies are needed depending on location and size of perforation. An intraperitoneal perforation can lead to laparotomy, bladder repair and open drainage of the abdominal cavity. Sudden adductor muscle spasm can occur when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope, especially when the surgeon is operating at the lateral wall of the bladder, where the obturator nerve runs in close proximity during its intrapelvic course. Therefore, the type of anesthesia is important in the lateral wall tumors of the bladder. Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. We aimed to form a review to reduce difficult situations and to minimize the adverse consequences caused by this reflex that becomes a nightmare in many surgical cases.

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CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip

Cited by 64 publications

References 4 publications

CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

An Obturator Nerve Block does not Alleviate Postoperative Pain after Total Hip Arthroplasty: a Randomized Clinical Trial

A nightmare during endoscopic bladder tumor resection; obturator reflex

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