Ultrasound-Guided Obturator Nerve Block Procedure

Patient Preparation and Equipment

The American Society of Anesthesiologists recommends patient positioning with the leg slightly abducted for the proximal approach technique 1
The American Society of Anesthesiologists suggests using standard aseptic technique similar to neuraxial procedures for equipment preparation 1
Calculate a safe dose of local anesthetic based on patient weight to prevent systemic toxicity, as recommended by the American Society of Anesthesiologists 2

Use ultrasound guidance to reduce the risk of local anesthetic systemic toxicity, as recommended by the American Society of Anesthesiologists 3
Use in-plane needling along the visual axis for improved speed and accuracy, as recommended by the American Society of Anesthesiologists 1
Monitor blood pressure and electrocardiogram, especially in patients with high cardiovascular risk, as recommended by the American College of Cardiology 2
Thoroughly test for block success before proceeding with surgery, as recommended by the American Society of Anesthesiologists 3

Avoid compression near the fibular head during patient positioning to prevent peroneal neuropathy, as recommended by the American Academy of Neurology 4
Balance the benefit of perineural adjuvants against risks of immunosuppression, sedation, bradycardia, and hypotension, as recommended by the American Society of Anesthesiologists 3

Position the ultrasound machine in front of the operator rather than perpendicular for improved accuracy, as recommended by the American Society of Anesthesiologists 1
Avoid turning the trunk, turning the head 45° or more, and non-dominant hand needling to prevent fatigue and suboptimal block performance, as recommended by the American Society of Anesthesiologists 1