Neurolytic blockade of the obturator nerve in the treatment of idiopatic obturator neuralgia

Abstract

Introduction. Idiopathic obturator neuralgia is a rare chronic pain condition. It consists of pain radiating from the obturator nerve territory to the inner thigh. However, the symptomatic obturator neuralgia is commonly caused by the obturator canal bowel hernia that causes painful compressive neuropathy in more than 85% of the cases. Case report. A 61-year-old female who underwent right femoral amputation due to the occlusion of the aortofemoral vascular graft, complained of the pain characterized by its localization in the inguinal region and anterointernal side of the right inner thigh. Computer tomography and MRI findings excluded obturator canal herniation or lumbar plexopathy. A diagnosis of the obturator neuralgia was confirmed by an analgesic block of the obturator nerve. Thereafter, the neurolitic blockade of the right obturator nerve was done. The complete pain relief was achieved. Pain relief was complete in three-month follow-up period. Conclusion. Neurolitic blockade is an efficacious method in treating chronic pain caused by the idiopathic obturator neuralgia.Uvod. Idiopatska opturatorna neuralgija redak je klinicki fenomen karakterisan bolom u ingvinalnom regionu i unutrasnjoj strani butine. Simptomatska neuralgija opturatornog nerva najcesce se javlja kao posledica opturatorne hernije, kada je neuralgicni bol u natkolenici vodeci simptom kod vise od 85% slucajeva. Prikaz bolesnika. Bolesnica, stara 61 godinu, patila je od hronicnog bola u unutrasnjoj strani natkolenice u periodu lecenja opstruktivne arterijske bolesti. Posto je bolni sindrom trajao i posle natkolene amputacije ekstremiteta koja je ucinjena zbog okluzije grafta, postavilo se pitanje etiologije bolnog sindroma. Kompjuterizovanom tomografijom i magnetnom rezonancijom iskljucene su opturatorna hernija i lumbalna radikulopatija kao uzroci bola. Dijagnostickom blokadom opturatornog zivca postavljena je dijagnoza opturatorne neuralgije, a izlecenje bola postignuto je fluoroskopski kontrolisanom alkoholnom neurolitickom blokadom opturatornog zivca. Zakljucak. Dijagnosticka blokada zivca korisna je metoda u diferencijalnoj dijagnostici etiologije bolnih stanja. Idiopatska opturatorna neuralgija maskirana klinickim stanjem okluzivne arterijske bolesti donjih ekstremiteta kod prikazane bolesnice uspesno je izlecena neurolitickom blokadom opturatornog nerva.