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Surg Radiol Anat (2008) 30:495501 DOI 10.1007/s00276-008-0358-x
ORIGINAL ARTICLE
The location of the obturator nerve: a three-dimensional description of the obturator canal
S. Kendir T. Akkaya A. Comert M. Sayin E. Tatlisumak A. Elhan I. Tekdemir
Received: 7 August 2007 / Accepted: 28 April 2008 / Published online: 14 May 2008 Springer-Verlag 2008
Abstract Satisfactory analgesia cannot be achieved in every obturator nerve block. To attempt to improve the success rate of obturator nerve block, this study describes the detailed anatomy of the obturator region and canal. Eleven (5 female and 6 male) cadavers, totally 22 sides were dissected. Anatomical positions of the structures entering and leaving the canal were deWned. The position of the obturator nerve and its branches and their relation with the obturator artery, vein, and with the internal iliac and femoral veins were investigated. A mould of the canal and a model were created. Detailed measurements were performed on the cadavers and models. The obturator canal was in the shape of a funnel compressed from superior to inferior, with anterior and posterior openings. At the entrance of the canal, the nerve lay superiorly; the artery was in the middle, and the vein lay inferiorly. The obturator nerve ran close to the lateral wall of the obturator canal. The distance of lateral wall
of obturator canal to the median plane was 41.4 1.1 mm. After leaving the canal, the nerve lay laterally while the anterior branch of the artery was medial. A venous plexus lay between the two structures. The presence of the branches of the obturator artery and vein alongside the obturator nerve may increase the risk of injury to these structures during anaesthetic procedures. The anterior division of the obturator nerve has a close relationship with these vessels. To provide complete analgesia, the obturator nerve should be blocked in the obturator canal or at its external oriWce.
Keywords Nerve block Anaesthesia Obturator nerve Obturator nerve block Obturator canal anatomy
Introduction
Winnie et al. [14] described the technique called femoral three-in-one nerve block, which was supposed to provide anaesthesia of the femoral, lateral cutaneous of the thigh and obturator nerves with a single injection of local anesthetic. Although this block is commonly applied, in clinical practice, satisfactory postoperative analgesia cannot...