- Email: [email protected]
Detection of large perforating artery by ultrasound prescan before obturator nerve block
Journal of Clinical Anesthesia (2016) 29, xxx–xxx
Correspondence Detection of large perforating artery by ultrasound prescan before obturator nerve block☆,☆☆,★ To the Editor An obturator nerve block improves the quality of postoperative analgesia after lower extremity surgery [1]. An ultrasound-guided obturator nerve block is simpler to perform and more reliable than other landmark techniques [2]. We report a case where a large perforating artery was detected by ultrasound prescan before applying the obturator nerve block. A 75-year-old man with bladder cancer was scheduled to undergo transurethral resection of the bladder tumor. After induction of the spinal anesthesia, bilateral obturator nerve blocks were attempted by performing the interfascial approach at the level of the femoral crease. An ultrasound prescan indicated the presence of a large artery near the anterior branch of the right obturator nerve between the adductor longus and the adductor brevis (Figure). By using the ultrasound probe, we detected that it branched out from the right deep artery of the thigh. Therefore, the artery was considered a large perforating artery from the right deep artery of thigh. We could not detect a similar abnormal large performing artery from the left deep artery. We performed bilateral obturator nerve block to avoid the large performing artery from the right deep artery. An unintentional pucture of a large perforating artery puncture during obturator nerve block can cause some complications such as hematoma and local anesthetic intoxication. We recommend that the vasculature be confirmed by an ultrasound prescan prior to performing an obturator nerve block.
☆ ☆☆ ★
Assistance with the letter: None. Financial support and sponsorship: None. Conflict of interest: None.
0952-8180/© 2015 Elsevier Inc. All rights reserved.
Hironobu Ueshima MD, PhD (Lecturer)⁎ Khine Zar Hla Myint MD Hiroshi Otake MD, PhD (Professor) Department of Anesthesiology, Showa University Hospital Tokyo, Japan Department of Anesthesiology, South Okkalapa Women and Children Hospital, Yangon, Myanmar ⁎ Corresponding author at: Department of Anesthesiology Showa University Hospital, Hatanodai Shinagawa-ku Tokyo, Japan Tel.: +81 03 3784 8875; fax: +81 03 3784 8575 E-mail address: [email protected] http://dx.doi.org/10.1016/j.jclinane.2015.10.007
References [1] Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, et al. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg 2004;99:251-4. [2] Helayel PE, da Conceicao DB, Pavei P, Knaesel JA, de Oliveira GR. Ultrasound-guided obturator nerve block: a preliminary report of a case series. Reg Anesth Pain Med 2007;32:221-6.
Figure Large perforating artery (white arrow) from the right deep artery of thigh is seen near the anterior branch of the obturator nerve (Ant. ONB). ALM: adductor longus, ABM: adductor brevis, PEC: pectineus.
Correspondence Detection of large perforating artery by ultrasound prescan before obturator nerve block☆,☆☆,★ To the Editor An obturator nerve block improves the quality of postoperative analgesia after lower extremity surgery [1]. An ultrasound-guided obturator nerve block is simpler to perform and more reliable than other landmark techniques [2]. We report a case where a large perforating artery was detected by ultrasound prescan before applying the obturator nerve block. A 75-year-old man with bladder cancer was scheduled to undergo transurethral resection of the bladder tumor. After induction of the spinal anesthesia, bilateral obturator nerve blocks were attempted by performing the interfascial approach at the level of the femoral crease. An ultrasound prescan indicated the presence of a large artery near the anterior branch of the right obturator nerve between the adductor longus and the adductor brevis (Figure). By using the ultrasound probe, we detected that it branched out from the right deep artery of the thigh. Therefore, the artery was considered a large perforating artery from the right deep artery of thigh. We could not detect a similar abnormal large performing artery from the left deep artery. We performed bilateral obturator nerve block to avoid the large performing artery from the right deep artery. An unintentional pucture of a large perforating artery puncture during obturator nerve block can cause some complications such as hematoma and local anesthetic intoxication. We recommend that the vasculature be confirmed by an ultrasound prescan prior to performing an obturator nerve block.
☆ ☆☆ ★
Assistance with the letter: None. Financial support and sponsorship: None. Conflict of interest: None.
0952-8180/© 2015 Elsevier Inc. All rights reserved.
Hironobu Ueshima MD, PhD (Lecturer)⁎ Khine Zar Hla Myint MD Hiroshi Otake MD, PhD (Professor) Department of Anesthesiology, Showa University Hospital Tokyo, Japan Department of Anesthesiology, South Okkalapa Women and Children Hospital, Yangon, Myanmar ⁎ Corresponding author at: Department of Anesthesiology Showa University Hospital, Hatanodai Shinagawa-ku Tokyo, Japan Tel.: +81 03 3784 8875; fax: +81 03 3784 8575 E-mail address: [email protected] http://dx.doi.org/10.1016/j.jclinane.2015.10.007
References [1] Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, et al. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg 2004;99:251-4. [2] Helayel PE, da Conceicao DB, Pavei P, Knaesel JA, de Oliveira GR. Ultrasound-guided obturator nerve block: a preliminary report of a case series. Reg Anesth Pain Med 2007;32:221-6.
Figure Large perforating artery (white arrow) from the right deep artery of thigh is seen near the anterior branch of the obturator nerve (Ant. ONB). ALM: adductor longus, ABM: adductor brevis, PEC: pectineus.