Share
array:23 [ "pii" => "S234119292300183X" "issn" => "23411929" "doi" => "10.1016/j.redare.2023.10.002" "estado" => "S300" "fechaPublicacion" => "2023-12-01" "aid" => "1514" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:569-74" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935623001573" "issn" => "00349356" "doi" => "10.1016/j.redar.2023.05.004" "estado" => "S300" "fechaPublicacion" => "2023-12-01" "aid" => "1514" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2023;70:569-74" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Bloqueo ecoguiado del nervio obturador al nivel de la rama púbica superior: estudio en cadáver embalsamado en Thiel utilizando látex" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "569" "paginaFinal" => "574" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Sonographic obturator nerve block at level of superior pubic ramus: A Thiel based cadaveric investigation with latex" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1740 "Ancho" => 2925 "Tamanyo" => 655014 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A) Bloqueo del nervio obturador derecho proximal. B) Diagrama esquemático de la colocación de la punta de la aguja entre los músculos pectíneo y obturador externo en el borde superior de las ramas púbicas. CObN: nervio obturador común; AL: aductor largo; AB: aductor corto; SPR: ramas púbicas superiores. C) En un voluntario, la sonda lineal ecográfica al nivel de las ramas púbicas superiores (SPR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>flecha azul claro), se movió lateralmente hasta que identificamos los músculos pectíneo y obturador externo de anterior a posterior. En el plano fascial entre los músculos pectíneo y obturador externo, el curso de los nervios obturadores y vasos (flecha amarillo oscuro<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>vía neurovascular del obturador) al emerger del canal del obturador (flecha verde). La aguja (rosa) se inserta de lateral a medial en el plano intermuscular. D) Aspecto ventral de la parte medial del triángulo femoral izquierdo; el ligamento inguinal está marcado mediante una línea verde claro (1: arteria epigástrica superficial; 2: vena safena mayor; P: músculo pectíneo; AL: aductor largo). E) Aspecto ventral de la parte medial del triángulo femoral izquierdo; el ligamento inguinal está marcado mediante una línea verde claro. SEA: arteria epigástrica superficial; GSV: vena safena mayor; AON: rama anterior del nervio obturador. P: el músculo pectíneo (que emerge de la rama púbica superior) es visible; AB: aductor corto; AL: aductor largo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Diwan, G. Feigl, A. Nair" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Diwan" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Feigl" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Nair" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S234119292300183X" "doi" => "10.1016/j.redare.2023.10.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119292300183X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623001573?idApp=UINPBA00004N" "url" => "/00349356/0000007000000010/v1_202311281201/S0034935623001573/v1_202311281201/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192923001269" "issn" => "23411929" "doi" => "10.1016/j.redare.2022.10.009" "estado" => "S300" "fechaPublicacion" => "2023-12-01" "aid" => "1511" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:575-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Postoperative arterial hypotension: the unnoticed enemy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "579" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipotensión arterial posoperatoria: el enemigo inadvertido" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.I. Monge García, I. Jiménez López, J.V. Lorente Olazábal, D. García López, A.R. Fernández López, A. Pérez Carbonell, J. Ripollés Melchor" "autores" => array:7 [ 0 => array:2 [ "nombre" => "M.I." "apellidos" => "Monge García" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Jiménez López" ] 2 => array:2 [ "nombre" => "J.V." "apellidos" => "Lorente Olazábal" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "García López" ] 4 => array:2 [ "nombre" => "A.R." "apellidos" => "Fernández López" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Pérez Carbonell" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "Ripollés Melchor" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935623001408" "doi" => "10.1016/j.redar.2022.10.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623001408?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001269?idApp=UINPBA00004N" "url" => "/23411929/0000007000000010/v2_202401250614/S2341192923001269/v2_202401250614/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2341192923001671" "issn" => "23411929" "doi" => "10.1016/j.redare.2023.01.006" "estado" => "S300" "fechaPublicacion" => "2023-12-01" "aid" => "1533" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:561-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "561" "paginaFinal" => "568" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de cohortes para evaluar la prevalencia de QT prolongado y arritmias en pacientes críticos durante la primera fase de la pandemia por COVID-19" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 784 "Ancho" => 2341 "Tamanyo" => 148986 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Example of QT interval measurement in patients with atrial fibrillation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Zaballos, I. Fernández, L. Rodríguez, S. Álvarez-Zaballos, P. Duque, E. Terradillos, P. Piñeiro, I. Garutti, J.E. Guerrero, J. Hortal" "autores" => array:10 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Zaballos" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Fernández" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Álvarez-Zaballos" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Duque" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Terradillos" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Piñeiro" ] 7 => array:2 [ "nombre" => "I." "apellidos" => "Garutti" ] 8 => array:2 [ "nombre" => "J.E." "apellidos" => "Guerrero" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "Hortal" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935623001755" "doi" => "10.1016/j.redar.2023.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623001755?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001671?idApp=UINPBA00004N" "url" => "/23411929/0000007000000010/v2_202401250614/S2341192923001671/v2_202401250614/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Report</span>" "titulo" => "Sonographic obturator nerve block at level of superior pubic ramus: a thiel based cadaveric investigation with latex" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "569" "paginaFinal" => "574" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Diwan, G. Feigl, A. Nair" "autores" => array:3 [ 0 => array:3 [ "nombre" => "S." "apellidos" => "Diwan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "G." "apellidos" => "Feigl" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "A." "apellidos" => "Nair" "email" => array:1 [ 0 => "abhijitnair95@outlook.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Anaesthesiology, Sancheti Hospital, Maharashtra, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institute of Anatomy and Clinical Morphology, Witten/Herdecke University, Witten, Germany, and Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Anaesthesiology, Ibra Hospital, North Sharqiya Governorate, Sultanate of Oman" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueo ecoguiado del nervio obturador al nivel de la rama púbica superior: estudio en cadáver embalsamado en Thiel utilizando látex" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 827 "Ancho" => 2091 "Tamanyo" => 342450 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Ventral aspect of a medial part of the left femoral triangle. OT- trunk of the obturator nerve; PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; P- Pectineus muscle (origin at the superior pubic ramus) is visible and mostly resected; OE- Obturator externus; AB- Adductor brevis; AL- Adductor longus. (B) Ventral aspect of a medial part of the left femoral triangle. PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; P- Pectineus muscle (origin at the superior pubic ramus) is visible and mostly resected; AB- Adductor brevis; AL- Adductor longus. (C) Ventral aspect of a medial part of the left femoral triangle. PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; b-AON- branches of AON; AB- Adductor brevis; AL- Adductor longus. (D) Ventral aspect of a medial part of the left femoral triangle. PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; b-PON- branches of PON; b-AON- branches of AON; AB- Adductor brevis; AL- Adductor longus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Obturator nerve blocks are frequently used as regional anesthetic blocks for surgical interventions on the lower limb and interventional pain techniques for hip joint.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Different approaches exist at various levels.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Some were developed for classic electro-stimulation guided techniques while others are described for US-guided approaches.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> The target is the inter-fascial plane between the pectineus and the obturator externus muscles. Technical differences exist amongst the approaches, such as transducer position, tilt or needle -ultrasound beam angle.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Embalmed cadavers were utilized to investigate the spread of injected methylene blue dye, and with immediate dissections revealed appropriate spread in the vicinity of the nerve, though the spread was extensive along the fascial planes with discolouration of the muscles.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our aim was to inject latex in the inter-fascial plane between pectineus and obturator externus and subsequently dissect the medial thigh 48 h later. We anticipated an unblemished spread of latex in the vicinity of the obturator nerve. This might lead to a better interpretation of results concerning the use of volumes for the obturator nerve block. As a consequence, we wanted to investigate, whether injection of 5 ml might be adequate for a predictable spread. The article adheres to Standards for Reporting of Diagnostic Accuracy Studies (STARD) guidelines.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Three investigated bodies donated to science (BDTS) fall under the strict rules of the donation program of the Department of Macroscopic and Clinical Anatomy of the Medical University of Graz and the Styrian burial law. The BDTS were embalmed with Thiel´s method which provides very lifelike conditions for investigations with regional anaesthesia backgrounds.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The cadavers (C1 and C2) were in supine position. An ultrasound scan (M-Turbo, Sonosite, Bothell, USA) with a linear transducer (3–12 mHz) was performed to envisage an in-plane optimal needle tip position for injection into the inter fascial plane between the pectineus and external obturator muscles close to the inferior margin of the superior pubic ramus. Initially the linear probe was placed immediately lateral to the palpable pubic tubercle.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The probe was moved laterally and caudally in order to insonate a parallel beam as done for scanning the obturator canal, in order to image the superior pubic rami. (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The pectineus and the obturator externus were identified (as in volunteer US image -(<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) and the interfascial plane between the two muscles was chosen for injection of latex. A 100 mm blunt needle (Stimuplex, B-Braun®, Melsungen, Germany) was inserted from the lateral to the medial and after reaching the desired target (interfascial plane between the pectineus and the obturator externus). A volume of 5 ml green latex was injected with a moderate pressure under real time ultrasound guidance. The spread of the latex was recorded, downloaded and saved in a separate file.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Two days after injection after ensuring that the latex have hardened, in supine position, the ventral aspect of medial thigh of both cadavers (C1 and C2) were dissected carefully by elevating all layers (skin, subcutaneous tissue). In C3, without injection of latex cross-section was performed at the level of left and right hip joints and the proximal of the thighs.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Autopsy presentation</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ultrasound</span><p id="par0035" class="elsevierStylePara elsevierViewall">In both cadavers (C1 and C2), the superior pubic rami, pectineus muscle, obturator externus muscle and the inter-fascial plane between the two were successfully identified (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The needle tip was located in the plane between the two muscle and the latex injection was visualized as a hyperechoic thin linear and elliptical spread.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Anatomical dissection</span><p id="par0040" class="elsevierStylePara elsevierViewall">A vertical incision from the mid of the inguinal crease until the mid-thigh and a medial horizontal incision exposed the medial thigh (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) after reflecting the skin and subcutaneous tissues. The superficial epigastric artery and the great saphenous vein were identified. Dissection through the fascia, further revealed the pectineus and the adductor longus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). The pectineus was partially divided to demonstrate the emergence of the anterior branch of the obturator nerve (AON) and coursing between the adductor brevis and longus muscles (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). The green latex was visualized occupying course lateral to the AON and beneath the pectineus muscle (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). Following the anterior branch of the obturator nerve proximally, the nerve disappeared beneath the inferior edge of the superior pubic ramus. Gentle dissection between the pectineus and the adductor brevis muscle disclosed the green latex which engulfed the posterior branch of the obturator nerve (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). At one point the green latex squeezed between the anterior and posterior obturator nerves. Latex was present lateral to the posterior branch of the obturator nerve. Pursing the posterior and anterior branches disclosed the obturator trunk disappearing in the obturator canal, beneath the inferior edge of the superior pubic ramus. The green latex was confined between the pectineus and obturator externus in the proximal area, where it engulfed the obturator trunk and the anterior branch of the obturator nerve (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). A distal spread was observed between the adductor longus and brevis along the course of the anterior branch of the obturator nerve (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The posterior branch of the obturator nerve was lifted with the forceps (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B), which was situated between the pectineus and obturator externus in the proximal part and the distally it disappeared deep to the adductor brevis. Dissection was carried out until the medial thigh, and after reflecting the adductor longus medially the anterior branches of the obturator nerves were divulged (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Gentle retraction of adductor brevis medially, exhibited the sheath beneath which the posterior branches of the obturator nerve and its branches were located (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). No latex was seen in the distal part of the anterior and posterior branches of the obturator nerve.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Anatomical cross-section</span><p id="par0045" class="elsevierStylePara elsevierViewall">At the level of hip joint, cross-sections revealed the pubis and the ilium. Along the quadrilateral surface the obturator internus could be seen as a thick muscular band. In the left hip joint specimen (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A) the obturator nerves could be visualized medial to the quadrilateral plate and superior to obturator internus muscle. In the right hip joint specimen (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B) the obturator nerve could be visualized sandwiched between the osseus-muscular canal which consisted the quadrilateral plate laterally and obturator internus medially.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">In the cross-sections of the proximal thigh of C3, the adductor muscles were stacked one over the other from top to bottom /above to below these are the adductor longus, brevis and magnus muscles (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3</a>C and 3D). Sandwiched between the longus and brevis were the branches of the anterior obturator nerves and between the adductor brevis and magnus were the branches of the posterior obturator nerves (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3</a>A and 3B). The sciatic nerve is situated in the posterior compartment.</p></span></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Our Thiel based cadaveric open dissection (C1 and C2) demonstrates that a single injection of latex in the inter-fascial plane between the pectineus muscle and the obturator externus muscle at the level of superior pubic ramus led to adequate spread along trunk of the obturator nerve and its branches in all specimens. Even more, a reduction of volume can be considered especially with the visualization of the nerve. In none of the specimens it led to extravasation. There was no unnecessary and unwanted spread along the fascial planes into the muscular tissues. The green latex was elegantly seen coursing along the obturator nerves.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ultrasound guided single needle proximal approaches for obturator nerve are mentioned in the literature.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6–9</span></a> Decreased in volumes of local anaesthetic agent is predicted with proximal approaches. Anatomic variations exist more in the distal obturator nerves, than the proximal ones.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> A study mentioned bifurcation of anterior and posterior branches of the obturator nerve to be intrapelvic (23.22%), within the obturator canal (51.78%), or in the medial thigh (25%). Thus, it would be prudent to inject local anaesthetic in the proximal than the distal area.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Cadavers immersed in phenolic acid solution after injection with ethanol-glycerol solutions were utilized for investigating the spread of methylene blue dye solution. Dissections were performed immediately after injection revealed spread of dye inside the obturator canal and soakage of the common, anterior and the posterior divisions of the obturator nerves. Spillage of the dye was seen on the fascia overlying the muscles with dye uptake by the muscles.</p><p id="par0070" class="elsevierStylePara elsevierViewall">As used in our study the best physical and functional properties were provided by the Thiel embalmed cadavers in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> As a matter of fact, the Thiel is endorsed to investigate the inter-fascial plane blocks.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The previous study of Feigl et al. already showed that a proximal insertion point will reach the trunk of the obturator nerve.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Main difference to this manuscript is, that the current investigation was performed with ultrasound guidance and chosen in plane technique. Feigl et al. chose a blind technique mainly feasible with the use of electrostimulation guidance with a vertically advanced needle and named it VOB (vertical obturator block). They found that the trunk of the obturator nerve is located in a very constant depth. This can be used for ultrasound guided techniques too.</p><p id="par0080" class="elsevierStylePara elsevierViewall">An aqueous dye is less viscous, and can influence the spread as it easily translocated through various tissues if compared to latex which is highly viscous. A combination of aqueous dye and latex has also been used in a cadaveric study.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> It is prudent to inject a solution with a viscosity higher than the local anaesthetic solution. This avoids unnecessary and unwanted spread across the fascia. In our study injection of 5 ml of green latex provided us with an appropriate spread along the course of the obturator nerves without staining the other tissues. Also, a delayed dissection avoided excessive spillage onto other tissues. Dissections performed immediately after injection of a solution can led to false spread, and probably the dye needs to get fixed to the tissues and latex needs to harden before embarking on dissection. However, we did not perform an intra-pelvic dissection this can be a major limitation of this study. A cross-section in a separate latex injected cadaver would have been ideal to visualize the deeper spread.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Based on our limited Thiel based cadaveric study, we postulate in-plane ultrasound guided latex injections at the level of superior pubic rami, between the pectineus and the obturator externus muscles will soak the anterior ramus, posterior ramus and the obturator nerve trunk. We further endorse the concept of standardizing the cadaveric methods to evaluate the mechanism of spread of injectate.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest [or state specific conflicts].</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no sources of funding to declare for this manuscript [or declare funding].</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2079403" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusiones" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1773943" "titulo" => "Palabras clave" ] 2 => array:3 [ "identificador" => "xres2079402" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1773944" "titulo" => "Keywords" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Autopsy presentation" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Ultrasound" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Anatomical dissection" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Anatomical cross-section" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-11-29" "fechaAceptado" => "2023-05-16" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1773943" "palabras" => array:5 [ 0 => "Cadáver" 1 => "Disección" 2 => "Látex" 3 => "Nervio obturador" 4 => "Ecografía" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1773944" "palabras" => array:5 [ 0 => "Cadaver" 1 => "Dissection" 2 => "Latex" 3 => "Obturator nerve" 4 => "Ultrasonography" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducción</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El bloqueo del nervio obturador proximal tiene una eficacia similar al bloqueo del nervio obturador distal. Los estudios en cadáveres previos que inyectaban azul de metileno y realizaban seguidamente la disección reflejaron que la solución se dispersa a las divisiones anterior y posterior del nervio obturador, en el punto de salida del canal obturador. La absorción de azul de metileno por parte de la fascia y los músculos oscurece la delineación exacta de los nervios teñidos. Nosotros conjeturamos que la inyección de látex al nivel de las ramas púbicas superiores en el plano entre los músculos pectíneo y obturador externo mediante guía ecográfica a tiempo real, seguida de disección demorada en un cadáver embalsamado en Thiel, sería la técnica óptima de investigación en cadáveres.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Métodos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Obtuvimos tres cuerpos donados a la ciencia (BDTS) conforme a las normas estrictas del programa de donación del Departamento de Anatomía Macroscópica y Clínica de la Universidad de Medicina de Graz, y a la normativa sobre enterramientos de Estiria. Los BDTS fueron embalsamados utilizando el método de Thiel, que aporta condiciones muy realistas para las investigaciones con anestesia regional. En dos cadáveres, las inyecciones de látex se realizaron de forma ecoguiada, y en el tercero se realizaron secciones transversales.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Nuestras disecciones abiertas de los cadáveres embalsamados en Thiel (C1 y C2) reflejaron que la inyección única de látex en el plano interfascial entre los músculos pectíneo y obturador externo al nivel de la rama púbica superior originó una dispersión adecuada a lo largo del tronco del nervio obturador y sus ramas, en todas las muestras.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La inyección ecoguiada de látex dentro del plano al nivel de las ramas púbicas superiores entre los músculos pectíneo y obturador externo cubre las ramas anterior y posterior y el tronco del nervio obturador.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusiones" ] ] ] "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A proximal obturator nerve block has a similar block efficacy as the distal obturator nerve block. Previous cadaveric investigation injecting methylene blue dye solution and an immediate dissection proved the solution engulfing the anterior and posterior divisions of the obturator nerve as they emerge from the obturator canal. Uptake of methylene blue dye by the fascia and muscles obscures the exact delineation of the stained nerves. We hypothesized that injection of latex at the level of superior pubic rami in the plane between pectineus and obturator externus under real time ultrasound and a delayed dissection in a Thiel-based cadaver would be the optimal cadaveric investigational technique.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Three investigated bodies donated to science (BDTS) fall under the strict rules of the donation program of the Department of Macroscopic and Clinical Anatomy of the Medical University of Graz and the Styrian burial law. The BDTS were embalmed with Thiel´s method which provides very lifelike conditions for investigations with regional anaesthesia backgrounds. In two cadavers (a total of specimens), latex injections were performed under ultrasound, while in the third cadaver cross-sections were executed.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Our Thiel based cadaveric open dissection (C1 and C2) demonstrated that a single injection of latex in the inter-fascial plane between the pectineus muscle and the obturator externus muscle at the level of superior pubic ramus led to adequate spread along trunk of the obturator nerve and its branches in all specimens.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An in-plane ultrasound-guided latex injections at the level of superior pubic rami, between the pectineus and the obturator externus muscles soaks the anterior ramus, posterior ramus, and the obturator nerve trunk.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1727 "Ancho" => 2917 "Tamanyo" => 642220 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Right Proximal Obturator Nerve Block. (B) Schematic diagram of needle tip placement between the pectineus and the obturator externus at the superior border of pubic rami. CObN- common obturator nerve; AL-Adductor longus; AB-Adductor Brevis; SPR-superior pubic rami. (C) In a volunteer, US linear probe at the level of superior pubic rami (SPR = light blue arrow), is shifted lateral to it until we identify the pectineus and the obturator externus muscles from anterior to posterior. In the fascial plane between the pectineus and the obturator externus, the obturator nerves and vessels (dark yellow arrow = obturator neurovascular pathway) course as they emerge from the obturator canal (green arrow). The needle (rose) is inserted from lateral to medial in the inter-muscular plane. (D) Ventral aspect of a medial part of the left femoral triangle; the inguinal ligament is marked by a green line (1-superficial epigastric artery; 2- great saphenous vein; P- Pectineus muscle; AL-Adductor longus). (E) Ventral aspect of a medial part of the left femoral triangle; the inguinal ligament is marked by a light green line. SEA- superficial epigastric artery, GSV- great saphenous vein, AON-anterior branch of the obturator nerve. P- Pectineus muscle (origin at the superior pubic ramus) is visible, AB- Adductor brevis, AL-Adductor longus (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 827 "Ancho" => 2091 "Tamanyo" => 342450 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Ventral aspect of a medial part of the left femoral triangle. OT- trunk of the obturator nerve; PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; P- Pectineus muscle (origin at the superior pubic ramus) is visible and mostly resected; OE- Obturator externus; AB- Adductor brevis; AL- Adductor longus. (B) Ventral aspect of a medial part of the left femoral triangle. PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; P- Pectineus muscle (origin at the superior pubic ramus) is visible and mostly resected; AB- Adductor brevis; AL- Adductor longus. (C) Ventral aspect of a medial part of the left femoral triangle. PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; b-AON- branches of AON; AB- Adductor brevis; AL- Adductor longus. (D) Ventral aspect of a medial part of the left femoral triangle. PON- posterior branch of the obturator nerve; AON- anterior branch of the obturator nerve; b-PON- branches of PON; b-AON- branches of AON; AB- Adductor brevis; AL- Adductor longus.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1614 "Ancho" => 2341 "Tamanyo" => 509000 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Cross section at level of a left hip joint. S- Sartorius muscle; IP- Iliopsoas muscle; TFL- Tensor fasciae lata muscle; Rf- Rectus femoris muscle; IT- iliotibial tract; GMe- Gluteus medius muscle; HoF- Head of Femur; FV- Femoral vein; FA- Femoral artery; FN- Femoral nerve; ON- obturator nerve; *- Psoas fascia. (B) Cross section at level of a right hip joint. S- Sartorius muscle; IP- Iliopsoas muscle; TFL- Tensor fasciae lata muscle; Rf- Rectus femoris muscle; IT- iliotibial tract; GMa- Gluteus maximus muscle; HoF- Head of Femur; FV- Femoral vein; FN- Femoral nerve; ON- obturator nerve. (C) Cross-section in the proximal left thigh. AL- adductor longus; AB- adductor brevis; AM- adductor magnus; AON- anterior branch of the obturator nerve; PON- posterior branch of the obturator nerve; GLmax- gluteus maximus. (D) Cross-section in the proximal right thigh. AL- adductor longus; AB- adductor brevis; AM- adductor magnus; AON- anterior branch of the obturator nerve; PON- posterior branch of the obturator nerve; GLmax- gluteus maximus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Over 500 obturator nerve blocks in the lithotomy position during transurethral resection of bladder tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Pladzyk" 1 => "L. Jureczko" 2 => "T. Lazowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5173/ceju.2012.02.art2" "Revista" => array:6 [ "tituloSerie" => "Cent European J Urol." "fecha" => "2012" "volumen" => "65" "paginaInicial" => "67" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24578931" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound and electrical stimulator-guided obturator nerve block with phenol in the treatment of hip adductor spasticity in long-term care patients: a randomized, triple blind, placebo controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Lam" 1 => "D. Wong" 2 => "C.K. Tam" 3 => "S.H. Wah" 4 => "M.W. Myint" 5 => "T.K. Yu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jamda.2014.10.005" "Revista" => array:6 [ "tituloSerie" => "J Am Med Dir Assoc." "fecha" => "2015" "volumen" => "16" "paginaInicial" => "238" "paginaFinal" => "246" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25458446" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The optimal analgesic block for total knee arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.F. Bendtsen" 1 => "B. Moriggl" 2 => "V. Chan" 3 => "J. Børglum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0000000000000485" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med." "fecha" => "2016" "volumen" => "41" "paginaInicial" => "711" "paginaFinal" => "719" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27685346" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided obturator nerve block: a focused review on anatomy and updated techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Yoshida" 1 => "T. Nakamoto" 2 => "T. Kamibayashi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Biomed Res Int." "fecha" => "2017" "volumen" => "2017" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomical investigation of a new vertical obturator nerve block technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.C. Feigl" 1 => "H. Ulz" 2 => "T. Pixner" 3 => "C. Dolcet" 4 => "R. Likar" 5 => "A. Sandner-Kiesling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aanat.2012.05.008" "Revista" => array:6 [ "tituloSerie" => "Ann Anat." "fecha" => "2013" "volumen" => "195" "paginaInicial" => "82" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22951254" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brief reports: ultrasound-guided obturator nerve block: a proximal interfascial technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.M. Taha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e318237fb40" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg." "fecha" => "2012" "volumen" => "114" "paginaInicial" => "236" "paginaFinal" => "239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22025494" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new ultrasound-guided pubic approach for proximal obturator nerve block: clinical study and cadaver evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Yoshida" 1 => "T. Onishi" 2 => "K. Furutani" 3 => "H. Baba" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.13336" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia." "fecha" => "2016" "volumen" => "71" "paginaInicial" => "291" "paginaFinal" => "297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26620274" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Akkaya" 1 => "E. Ozturk" 2 => "A. Comert" 3 => "Y. Ates" 4 => "H. Gumus" 5 => "H. Ozturk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ane.0b013e3181966f03" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg." "fecha" => "2009" "volumen" => "108" "paginaInicial" => "1037" "paginaFinal" => "1041" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19224822" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound standard for obturator nerve block: the modified Taha’s approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Lin" 1 => "T. Nakamoto" 2 => "S.D. Yeh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aeu467" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth." "fecha" => "2015" "volumen" => "114" "paginaInicial" => "337" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25596216" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A cadaveric study of ultrasound-guided subpectineal injectate spread around the obturator nerve and its hip articular branches" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.D. Nielsen" 1 => "B. Moriggl" 2 => "K. Søballe" 3 => "J.A. Kolsen-Petersen" 4 => "J. Børglum" 5 => "T.F. Bendtsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0000000000000587" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med." "fecha" => "2017" "volumen" => "42" "paginaInicial" => "357" "paginaFinal" => "361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28263244" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomic variations of the obturator nerve in the inguinal region: implications in conventional and ultrasound regional anesthesia techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Anagnostopoulou" 1 => "G. Kostopanagiotou" 2 => "T. Paraskeuopoulos" 3 => "C. Chantzi" 4 => "E. Lolis" 5 => "T. Saranteas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0b013e3181933b51" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med." "fecha" => "2009" "volumen" => "34" "paginaInicial" => "33" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19258986" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of fresh and Thiel’s embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Benkhadra" 1 => "A. Faust" 2 => "S. Ladoire" 3 => "O. Trost" 4 => "P. Trouilloud" 5 => "C. Girard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00276-009-0477-z" "Revista" => array:6 [ "tituloSerie" => "Surg Radiol Anat." "fecha" => "2009" "volumen" => "31" "paginaInicial" => "531" "paginaFinal" => "535" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19225711" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Munirama" 1 => "R. Eisma" 2 => "M. Columb" 3 => "G.A. Corner" 4 => "G.A. McLeod" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aev548" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth." "fecha" => "2016" "volumen" => "116" "paginaInicial" => "699" "paginaFinal" => "707" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27106974" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => ""Minimally invasive" regional anesthesia and the expanding use of interfascial plane blocks: the need for more systematic evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.V. Sondekoppam" 1 => "B.C.H. Tsui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-019-01400-0" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth." "fecha" => "2019" "volumen" => "66" "paginaInicial" => "855" "paginaFinal" => "863" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31114940" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.M. Yang" 1 => "Y.J. Choi" 2 => "H.J. Kwon" 3 => "OJ" 4 => "T.H. Cho" 5 => "SH. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.14408" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia." "fecha" => "2018" "volumen" => "73" "paginaInicial" => "1244" "paginaFinal" => "1250" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30113699" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000010/v2_202401250614/S234119292300183X/v2_202401250614/en/main.assets" "Apartado" => array:4 [ "identificador" => "36321" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000010/v2_202401250614/S234119292300183X/v2_202401250614/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119292300183X?idApp=UINPBA00004N" ]
