Kobayashi M, Takeyoshi S, Takiyama R, Seki E, Tsuno S, Hidaka S, Fukuda H, Inada K
Department of Anesthesia, Matsuyama Red Cross Hospital.
Masui. 1991 Jul;40(7):1138-43.
The obturator nerve passes in close proximity to the inferolateral bladder wall. Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective to stop adductor spasm during spinal anesthesia. We performed obturator nerve block in 107 cases by use of insulated needle and nerve stimulator, and measured the depth of the obturator nerve and that of the pubic tubercle. Obesity index was positively correlated with the depth of the obturator nerve as well as the pubic tubercle. However, no correlation was found between the obesity index and the difference of the depth of the obturator nerve and the depth of the pubic tubercle. It is suggested that if the needle is advanced in the direction of the obturator canal about 40mm further after reaching the pubic tubercle, the needle reaches the obturator nerve.
闭孔神经紧邻膀胱下外侧壁走行。经尿道切除靠近这些区域的膀胱肿瘤可能刺激闭孔神经，导致内收肌剧烈收缩并可能意外造成膀胱穿孔。为避免这种反应，在脊髓麻醉期间，当闭孔神经穿过闭孔管时对其进行局部麻醉阻滞可有效阻止内收肌痉挛。我们使用绝缘针和神经刺激器对107例患者进行了闭孔神经阻滞，并测量了闭孔神经和耻骨结节的深度。肥胖指数与闭孔神经深度以及耻骨结节深度呈正相关。然而，未发现肥胖指数与闭孔神经深度和耻骨结节深度之差之间存在相关性。建议在到达耻骨结节后，将针沿闭孔管方向再进针约40mm，即可到达闭孔神经。
