Ghai Anju, Sangwan Sukhbir Singh, Hooda Sarla, Garg Nidhi, Kundu Zile S, Gupta Tushar
Department of Anaesthesiology and Pain Clinic, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India.
Department of Orthopedics and Rehabilitation, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India.
Saudi J Anaesth. 2013 Oct;7(4):420-6. doi: 10.4103/1658-354X.121074.
Spasticity is a syndrome associated with a persistent increase in involuntary reflex activity of a muscle in response to stretch. Adductor muscle spasticity is a common complication of spinal cord and brain injury. It needs to be treated if it interferes with activities of daily living and self-care. Obturator neurolytic blockade is one of the cost-effective therapeutic possibilities to treat spasticity of adductor group of muscles. In this study, we assessed the efficacy of interadductor approach in alleviating the spasticity.
Obturator neurolysis using 8-10 ml 6% phenol was given with the guidance of a peripheral nerve stimulator in 20 spastic patients. Technical evaluation included number of attempted needle insertions, time to accurate location of the nerve, depth of needle insertion, and success rate. Pain, spasticity, hip abduction range of motion (ROM), number of spasms, gait, and hygiene were evaluated at 1(st) hour, 24(th) hour, end of the 1(st) week, and in the 1(st), 2(nd), and 3(rd) months following the intervention.
The success rate was 100% with mean time to accurate nerve location 4.9±2.06 min. Average depth of needle insertion was 2.91±0.32 cm. Compared with the scores measured immediately before the block, all studied parameters improved significantly. An increase in the Modified Ashworth Scale values was observed in the 2(nd) and 3(rd) months, but they did not reach their initial values.
The interadductor approach proved to be accurate and fast, with a high success rate. Phenol blockade is an efficient and cost-effective technique in patients with adductor spasticity. It led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene, with an efficacy lasting for about 3 months.
痉挛是一种与肌肉在受到拉伸时非自愿反射活动持续增加相关的综合征。内收肌痉挛是脊髓和脑损伤的常见并发症。如果它干扰日常生活和自我护理活动，则需要进行治疗。闭孔神经溶解阻滞是治疗内收肌群痉挛的一种经济有效的治疗方法。在本研究中，我们评估了经内收肌入路缓解痉挛的疗效。
在20例痉挛患者中，在周围神经刺激器引导下使用8 - 10 ml 6%苯酚进行闭孔神经溶解术。技术评估包括进针尝试次数、神经准确定位时间、进针深度和成功率。在干预后的第1小时、第24小时及第一周结束时以及第1、2、3个月评估疼痛、痉挛、髋关节外展活动度（ROM）、痉挛次数、步态和卫生状况。
成功率为100%，神经准确定位的平均时间为4.9±2.06分钟。进针平均深度为2.91±0.32厘米。与阻滞前立即测量的评分相比，所有研究参数均有显著改善。在第2和第3个月观察到改良Ashworth量表值有所增加，但未达到初始值。
经内收肌入路被证明准确、快速，成功率高。苯酚阻滞对于内收肌痉挛患者是一种有效且经济的技术。它导致痉挛和疼痛减轻，髋关节ROM增加且卫生状况改善，疗效持续约3个月。
