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Selective Blocking of the Anterior Branch of the Obturator Nerve in Children with Cerebral Palsy

Kwon, Jeong-Yi MD, PhD; Kim, Joon-Sung MD, PhD

American Journal of Physical Medicine & Rehabilitation: January 2009 - Volume 88 - Issue 1 - p 7-13
doi: 10.1097/PHM.0b013e31815b6381
Original Research Article: Cerebral Palsy
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Kwon J-Y, Kim J-S: Selective blocking of the anterior branch of the obturator nerve in children with cerebral palsy. Am J Phys Med Rehabil 2009;88:7–13.

Objective: To evaluate the effect of selective blocking of the anterior branch of the obturator nerve by using phenol in controlling adductor spasticity in children with cerebral palsy.

Design: To study the anatomic location of the anterior branch of the obturator nerve with respect to bony landmarks in the inguinal area, 12 limbs of seven adult cadavers were anatomically dissected. We injected 22 anterior branches of obturator nerves in 11 children with spastic cerebral palsy with 5% aqueous phenol guided by anatomical landmarks and electrical stimulation. The range of motion (ROM) of hip abduction and the modified Ashworth scale (MAS) grade of the hip adductors were measured preinjection, and at 1, 3, 6, and 12 mos after injection.

Results: Successful clinical results (range of hip abduction greater than 45 degrees with the knee extended) were achieved in all the children immediately after the injection. The average volume of 5% aqueous phenol injected per nerve was 0.79 ± 0.20 ml (0.12 ± 0.02 ml/kg). The effect was maintained for more than 6 mos. No immediate or delayed complications were observed.

Conclusions: Selective blocking of the anterior branch of the obturator nerve with 5% aqueous phenol can safely and effectively control adductor spasticity in children with cerebral palsy.

From The Catholic University of Korea, Department of Physical Medicine and Rehabilitation, St. Vincent Hospital, Suwon, Korea.

All correspondence and requests for reprints should be addressed to Jeong-Yi Kwon, MD, PhD, Assistant Professor, The Catholic University of Korea, Department of Physical Medicine and Rehabilitation, St. Vincent Hospital, Ji-dong 93, Paldal-gu, Suwon, 442-723 Korea.

© 2009 Lippincott Williams & Wilkins, Inc.