Brain Neurorehabil.  2012 Sep;5(2):82-86. 10.12786/bn.2012.5.2.82.

Obturator Nerve Block Using Ultrasound-guided Intraneural Alcohol Injection in Patient with Hip Adductor Spasticity

• Byun SD
• Park DH
• Choi WD
• Hong YH
• Lee ZI
• Kim CH

• KMID: 2270745
• DOI: http://doi.org/10.12786/bn.2012.5.2.82

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.
RESULTS
There were statistically significant improvement was seen in MAS of hip adductors and hip abduction angle at 1, 4, and 12 weeks after ultrasound guided intraneural injection, compared with parameters measured at previous injection (p<0.05).
CONCLUSION
Ultrasound guided intraneural alcohol injection into anterior branch of obturator nerve for treatment of hip adductor spasticity in patients with quadriplegia is an effective and safe procedure for relieving localized spasticity of the hip adductors.

Keyword

hip adductor spasticity; obturator nerve block; ultrasound

MeSH Terms

Hip
Humans
Leg
Ligaments
Muscle Spasticity
Needles
Obturator Nerve
Peripheral Nerves
Quadriplegia
Stress, Psychological
Supine Position

Figure

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  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. 2 Ultrasound 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. 3 Change 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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  Fig. 4 Change of abduction (degrees) of hip joint after sono-guided intraneural alcohol injection at anterior branch of obturator nerve. *p<0.05 vs. pre-injection.

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