超声引导闭孔神经阻滞：筋膜间注射与神经刺激辅助技术。

Ultrasound-guided obturator nerve block: interfascial injection versus a neurostimulation-assisted technique.

机构信息

Department of Anesthesiology, S. Croce e Carle Hospital, Cuneo, Italy.

出版信息

Reg Anesth Pain Med. 2012 Jan-Feb;37(1):67-71. doi: 10.1097/AAP.0b013e31823e77d5.

DOI:10.1097/AAP.0b013e31823e77d5

PMID:22157744

Abstract

BACKGROUND AND OBJECTIVES

Interfascial injection of local anesthetic under ultrasound guidance has been proposed as a new technique for performing an obturator nerve block. We hypothesized that interfascial needle placement could supplant nerve stimulation as the end point for local anesthetic injection during ultrasound-guided obturator nerve block after the division of the obturator nerve.

METHODS

Fifty spinal anesthesia patients who had experienced unilateral adductor muscle spasm during transurethral bladder tumor resection were randomly allocated to receive either 5 mL of lidocaine 2% injected under ultrasound guidance into the interfascial plane between the adductor longus and the adductor brevis and between the adductor brevis and the magnus muscles (US group) or an injection of 5 mL of lidocaine 2% in combination with nerve stimulation after identification of the divisions of the obturator nerve (USENS group). At 5, 10, and 15 minutes after block placement, muscle spasm was assessed by an independent observer masked to treatment allocation. The primary outcome was motor block onset time. Secondary outcomes were block performance time, total anesthesia-related time, motor block success at 15 minutes, and number of needle passes.

RESULTS

Motor block onset time did not differ between the 2 groups (6.2 minutes for USENS versus 7.2 minutes for US group, P = 0.225), block performance time was longer in the USENS than in the US group (3.0 versus 1.6 minutes, P < 0.001), and total anesthesia-related time did not differ between the 2 groups (9.2 versus 8.9 minutes, P = 0.71). Block success rate at 15 minutes was 100% in the USENS group and 88% in the US group (P = 0.23). There was no difference in the number of needle passes (2.3 versus 2.1, P = 0.28).

CONCLUSIONS

In ultrasound-guided obturator nerve block performed after the division of the nerve, injection of local anesthetic between the planes of the adductor muscles is comparable to nerve stimulation.

摘要

背景和目的

在超声引导下于局部麻醉药行筋膜间注射，已被提议作为一种新的闭孔神经阻滞技术。我们假设，在闭孔神经分离后，筋膜间置针可替代神经刺激，作为超声引导下闭孔神经阻滞中局部麻醉药注射的终点。

方法

50 例接受经尿道膀胱肿瘤切除术的患者，在术中出现单侧内收肌痉挛，这些患者被随机分配至接受超声引导下于内收长肌和内收短肌之间以及内收短肌和大收肌之间的筋膜间平面注射 5mL2%利多卡因（US 组），或在确认闭孔神经分支后，注射 5mL2%利多卡因联合神经刺激（USENS 组）。阻滞放置后 5、10 和 15 分钟，由一位对治疗分配不知情的独立观察者评估肌肉痉挛情况。主要结局是运动阻滞的起始时间。次要结局是阻滞操作时间、总麻醉相关时间、15 分钟时的运动阻滞成功率以及进针次数。

结果

两组间运动阻滞起始时间无差异（USENS 组为 6.2 分钟，US 组为 7.2 分钟，P = 0.225），USENS 组的阻滞操作时间长于 US 组（3.0 分钟比 1.6 分钟，P < 0.001），两组间总麻醉相关时间无差异（9.2 分钟比 8.9 分钟，P = 0.71）。USENS 组 15 分钟时的阻滞成功率为 100%，US 组为 88%（P = 0.23）。进针次数无差异（2.3 次比 2.1 次，P = 0.28）。