Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran.
J Endourol. 2010 Oct;24(10):1651-4. doi: 10.1089/end.2009.0659.
To evaluate the efficacy of transvesical obturator nerve block (ONB) in the prevention of obturator nerve reflex and leg jerking during transurethral resection of bladder tumors (TURBT).
A total of 60 patients were studied, in whom the transurethral resection of tumors on the posterolateral bladder wall were performed under spinal anesthesia (SA). The patients were randomly divided into two groups. In the first group, we performed transvesical ONB and SA together, while the second group received only SA. The patients underwent TURBT using monopolar cautery. Incidence of leg jerking was registered and compared in these two groups. We used a nerve stimulator to detect the obturator nerve next to the lateral bladder wall. The obturator nerve was identified by its response to nerve stimulation. Then, 10 mL of 1% lidocaine was slowly injected through the working channel of a cystoscope.
In the intervention group, 34 ONBs (4 bilateral and 26 unilateral) were tried. We could not detect the obturator nerve by nerve stimulation in six patients, and lidocaine injection was carried out blindly in these cases. One patient in the intervention group experienced adductor contraction. Among 30 patients in the control group, 5 patients had leg jerking, and in 2 patients, the procedure ended incompletely because of muscle spasm. Comparing these two groups, transvesical ONB effectively decreased leg jerking during TURBT (16.5% vs 3%; P < 0.05).
Local blockade of the obturator nerve during cystoscopy is an effective method to avoid its stimulation in TURBT. It can be performed easily, and we did not experience any serious complication.
评估经膀胱闭孔神经阻滞（ONB）在预防经尿道膀胱肿瘤电切术（TURBT）中闭孔神经反射和腿部反射的疗效。
共研究了 60 例患者，他们均在脊髓麻醉（SA）下接受后外侧膀胱壁肿瘤的经尿道切除术。患者被随机分为两组。在第一组中，我们同时进行经膀胱 ONB 和 SA，而第二组仅接受 SA。患者使用单极电切进行 TURBT。在这两组中记录并比较腿部反射的发生率。我们使用神经刺激器在侧膀胱壁旁探测闭孔神经。闭孔神经通过对神经刺激的反应来识别。然后，通过膀胱镜的工作通道缓慢注入 10 毫升 1%利多卡因。
在干预组中，尝试了 34 次 ONB（4 次双侧和 26 次单侧）。我们在 6 名患者中无法通过神经刺激检测到闭孔神经，并在这些情况下进行了盲目利多卡因注射。干预组中有 1 名患者出现内收肌收缩。在对照组的 30 名患者中，有 5 名患者出现腿部反射，其中 2 名患者因肌肉痉挛而未能完成手术。将这两组进行比较，经膀胱 ONB 可有效降低 TURBT 期间的腿部反射（16.5%比 3%；P<0.05）。
在膀胱镜检查期间局部阻滞闭孔神经是避免其在 TURBT 中受刺激的有效方法。它可以轻松进行，并且我们没有遇到任何严重的并发症。
