Helayel Pablo E, Ceccon Maurício S, Knaesel Julian A, Conceição Diogo B, de Oliveira Filho Getúlio R
Department of Anesthesiology, Nucleus for Teaching and Research in Regional Anesthesia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil.
Reg Anesth Pain Med. 2006 Jul-Aug;31(4):368-71. doi: 10.1016/j.rapm.2006.03.007.
The authors describe the occurrence of urinary incontinence after bilateral parasacral sciatic-nerve blocks.
Two female patients scheduled for bilateral hallux valgus corrective surgery under bilateral parasacral sciatic-nerve block developed urinary incontinence manifested by 3 episodes of enuresis in the first 5 hours after surgery. Physical examination revealed bilateral perineal and gluteal anesthesia and no bladder distention in both patients. Ten hours after block placement, both patients had recovered perineal sensibility and were able to control micturition.
Given the anatomic relations between the sacral plexus and the autonomic and somatic afferent and efferent innervation of the bladder and urethra, the urinary incontinence observed in our 2 patients could be explained by loss of afferent activity by spread of the local-anesthetic solution to pelvic nerves, loss of the efferent innervation of the posterior urethral sphincter by spread of the local-anesthetic solution to the urethral branches of the hypogastric plexus, and loss of external urethral sphincter tonus by block of the pudendal nerves. Anesthesiologists should consider the possibility of occurrence of urinary incontinence when performing bilateral parasacral sciatic-nerve blocks.
作者描述双侧骶旁坐骨神经阻滞术后尿失禁的发生情况。
两名计划在双侧骶旁坐骨神经阻滞下进行双侧拇外翻矫正手术的女性患者，术后前5小时出现3次遗尿，表现为尿失禁。体格检查发现两名患者均有双侧会阴和臀部麻醉，且膀胱无膨胀。阻滞放置10小时后，两名患者的会阴感觉均已恢复，能够控制排尿。
鉴于骶丛与膀胱和尿道的自主神经及躯体传入和传出神经支配之间的解剖关系，我们两名患者中观察到的尿失禁可解释为局部麻醉药溶液扩散至盆腔神经导致传入活动丧失、局部麻醉药溶液扩散至腹下丛尿道分支导致后尿道括约肌传出神经支配丧失以及阴部神经阻滞导致尿道外括约肌张力丧失。麻醉医生在进行双侧骶旁坐骨神经阻滞时应考虑尿失禁发生的可能性。
