A Selective Anterior Obturator Nerve Block for Total Hip Arthroplasty

An 83 year-old male with history of hypertension, complete heart block with a pacemaker, ankylosing spondylitis, prostate cancer, obesity and obstructive sleep apnea was scheduled for a right total hip arthroplasty (THA) for degenerative hip disease. His daily analgesic medications included oxycodone 5 milligrams (mg) every 3 hours, gabapentin 600 mg nightly, acetaminophen 650 mg every 6 hours and meloxicam 15 mg daily. A focused airway examination revealed a Mallampati III oropharyngeal exam, thyromental distance less than 6 centimeters, limited mouth opening and limited jaw protrusion. After a lengthy discussion regarding his anesthetic options, the patient elected for general endotracheal anesthesia and agreed to an obturator nerve block in the recovery room if postoperative analgesia proved difficult. The patient had taken his nightly dose of gabapentin and morning dose of acetaminophen prior to hospital arrival. In the preoperative area, he was given celecoxib 200 mg in addition as part of a comprehensive preoperative multimodal therapy.