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Abstract
Objective
To investigate the effects of obturator nerve blocks with ultrasound guided intraneural alcohol injection.
Method
Nine quadriplegic patients suffering hip adductor spasticity were included in this study. The obturator nerve was identified at just below inguinal ligament area on anteromedial surface of upper leg at supine position. An 23 G needle was inserted into anterior branch of obturator nerve under real time ultrasonography. The 50% alcohol solution was injected 3~5 ml at a time within the epineurium of the anterior branch of obturator nerve until the expanding nerve was visualized. We examed modified Ashworth scale (MAS) of hip adductor and passive range of movement of hip abduction at supine position at study entry, 1, 4, and 12 weeks after ultrasound guided intraneural injection.
Figures and Tables
 | Fig. 1(A) The anterior branch of obturator nerve (arrow head) located between three muscles, adductor longus, adductor brevis and pectineus. (B) When the needle (arrow) was located in the anterior branch of obturator nerve, and intra-neural alcohol injection was done.
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 | Fig. 2Ultrasound image of intraneural alcohol injection with the epineurium of anterior branch of obturator nerve. Fascicular bundles are being separated by 50% alcohol injection. F: Nerve fascicles, Arrows: Outer epineurium.
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 | Fig. 3Change of hip adductor spasticity after sono-guided intraneural alcohol injection at anterior branch of obturator nerve. *p<0.05 vs. pre-injection. MAS: Modified Ashworth scale.
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References
1. Akkaya T, Unlu E, Alptekin A, Gumus HI, Umay E, Cakci A. Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity. Acta Anaesthesiol Scand. 2010. 54:79–85.
2. Kwon JY, Kim JS. Selective blocking of the anterior branch of obturator nerve in children with cerebral palsy. Am J Phys Med Rehabil. 2009. 88:7–13.
3. Ward AB. A summary of spasticity management-a treatment algorithm. Eur J Neurol. 2002. 9:48–52.
4. Hyman N, Barnes M, Bhakta B, Cozens A, Bakheit M, Kreczy-Kleedorfer B, Poewe W, Wissel J, Bain P, Glickman S, Sayer A, Richardson A, Dott C. Botulinum toxin treatment of hip adductor spasticity in multiple sclerosis:a prospective, randomized, double blind, placebo controlled, dose ranging study. J Neurol Neurosurg Psychiatry. 2000. 68:707–712.
5. Kocabas H, Salli A, Demir AH, Ozerbil OM. Comparison of phenol and alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for treatment of spastic foot after stroke: a randomized controlled pilot study. Eur J Phys Rehabil Med. 2010. 46:5–10.
6. Viel E, Pellas F, Ripart J, Pelissier J, Eledjam JJ. Peripheral nerve blocks and spasticity. Why and how should we use regional blocks? Presse Med. 2008. 37:1793–1801.
7. Kim SS, Jang KU, Kim JC, Lee JH, Jeong KI, Park DS. Evaluation of nerve block after phenol and ethanol injection. J Korean Acad Rehabil Med. 2002. 26:470–474.
8. Manassero A, Bossolasco M, Uques S, Palmisano S, De Bonis U, Coletta G. Ultrasound-guided obturator nerve block: interfascial injection versus a neurostimulation-assisted technique. Reg Anesth Pain Med. 2012. 37:67–71.
9. Lee JM, Lee YS. Percutaneous chemical nerve block with ultrasound-guided intraneural injection. Eur Radiol. 2008. 18:1506–1512.
10. Akkaya T, Ozturk E, Comert A, Ates Y, Gumus H, Ozturk H, Tekdemir I, Elhan A. Ultrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach. Anesth Analg. 2009. 108:1037–1041.
11. Choquet O, Capdevila X, Bennourine K, Feugeas JL, Bringuier-Branchereau S, Manelli JC. A new inguinal approach for the obturator nerve block. Anatomical and randomized clinical studies. Anesthesiology. 2005. 103:1238–1245.
12. Fujiwara Y, Sato Y, Kitayama M, Shibata Y, Komatsu T, Hirota K. Obturator nerve block using ultrasound guidance. Anesth Analg. 2007. 105:888–889.
13. Shin DY, Lennard TA. Lennard TA, editor. Proximal lower extremity blocks. Physical Procedures in Clinical Practice. 1995. Philadephia: Hanley & Belfus Inc;150–156.
14. Kahle W, Leonhardt H, Platzer W. Nervous System and Sensory Organs. 1993. 4th ed. Stuttgart: Georg Theme Verlag;84–85.
15. Kwon JY, Kim JS. Selective blocking of the anterior branch of obturator nerve in children with cerebral palsy. Am J Phys Med Rehabil. 2009. 88:7–13.
16. Chua KS, Kong KH. Clinical and functional outcome after alcohol neurolysis of the tibial nerve for ankle-foot spasticity. Brain Inj. 2001. 15:733–739.
17. Jang SH, Ahn SH, Park SM, Kim SH, Lee KH, Lee ZI. Alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke. Arch Phys Med Rehabil. 2004. 85:506–508.
18. Carpenter EB, Seitz DG. Intramuscular alcohol as an aid in management of spastic cerebral palsy. Develop Med Child Neurol. 1980. 22:497–501.
19. Elvic E, Bogey R. Delisa JA, Gans BM, Walsh NE, Bockenek WL, Frontera WR, Geringer ST, Gerber LH, Pease WS, Robinson LR, Smith J, editors. Spasaticity and movement disorder. Physical Medicine and Rehabilitation: Principles and Practive. 2005. 4th ed. Philadelphia: Lippincott Wilianms & Wilkins;1427–1446.
20. Bang IK, Kim C, Ahn JK, Park YK, Reu HW, Jung IT. Sonographically Guided Musculocutaneous Nerve Phenol Block for Elbow Flexor Spasticity: Case report. J Korean Acad Rehabil Med. 2007. 31:371–374.
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