Thallaj Ahmed, Rabah Dany
Assistant Professor of Anesthesia, Urologist, College of Medicine, King Saud University, Riyadh, KSA.
Saudi J Anaesth. 2011 Jan;5(1):42-4. doi: 10.4103/1658-354X.76507.
During transurethral resection surgery (TUR), accidental stimulation of the obturator nerve can cause violent adductor contraction, leading to serious intraoperative complications. General anesthesia with muscle relaxation is currently the preferred technique for TUR surgery. Spinal anesthesia combined with obturator nerve block has also been used for TUR surgery in geriatric population. Blind, anatomical methods for identifying the obturator nerve are often unsatisfactory. Therefore, we conducted this prospective study to validate the efficacy of ultrasound-guided obturator nerve block (USONB) during TUR procedures.
Eighteen male patients undergoing TURP surgery under spinal anesthesia were included in the study. Bilateral USONB with maximum 20 ml of 1% lidocaine per patient was performed. An independent observer was present to monitor any adduction movements during the operation and to record patient and surgeon satisfactions.
In all patients, obturator nerve was visualized from the first attempt, requiring an average of 4.3 min for blocking of each side. USONB was successful (97.2%) in preventing an adductor spasm in all except one patient. Patient's and surgeon's satisfaction were appropriate. In all patients, adductor muscle strength recovered fully within 2 h following the surgical procedure.
USONB is safe and effective during TUR surgery. It provides optimal intra-and postoperative conditions.
在经尿道切除术（TUR）手术过程中，意外刺激闭孔神经可导致内收肌剧烈收缩，引发严重的术中并发症。目前，全身麻醉联合肌肉松弛是TUR手术的首选技术。脊髓麻醉联合闭孔神经阻滞也已用于老年患者的TUR手术。采用盲法、解剖学方法识别闭孔神经往往效果不佳。因此，我们开展了这项前瞻性研究，以验证超声引导下闭孔神经阻滞（USONB）在TUR手术中的有效性。
本研究纳入了18例在脊髓麻醉下接受经尿道前列腺切除术（TURP）的男性患者。对每位患者进行双侧USONB，每侧最大使用20 ml 1%利多卡因。有一名独立观察员在手术过程中监测任何内收运动，并记录患者和外科医生的满意度。
所有患者均在首次尝试时就成功可视化闭孔神经，每侧阻滞平均需要4.3分钟。除一名患者外，USONB成功预防内收肌痉挛的成功率为97.2%。患者和外科医生的满意度都很高。所有患者内收肌力量在手术后2小时内完全恢复。
USONB在TUR手术中安全有效。它可提供最佳的术中及术后条件。
