Moningi Srilata, Durga Padmaja, Ramachandran Gopinath, Murthy Pisapati Venkata Lakshmi Narasimha, Chilumala Rami Reddy
Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciecnes, Hyderabad, Andhra Pradesh, India.
Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciecnes, Hyderabad, Andhra Pradesh, India.
J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):41-5. doi: 10.4103/0970-9185.125702.
Selective obturator nerve blockade (ONB) is an effective option to prevent adductor spasm during transurethral resection of bladder tumors (TURBT) involving the lateral wall under spinal anesthesia (SA). The classic approach is less popular as the obturator nerve is deep seated and associated with vascular injury. The inguinal approach was described as a safer alternative. This randomized clinical study was undertaken to compare the ease of block, the success rate and complications of the classic pubic and superficial inguinal approach for ONB.
A total of 30 patients scheduled to undergo TURBT under SA were administered bilateral ONB. Inguinal approach recently described by Choquet was performed on one side and classic approach described by Labat was performed on the other side in random order using a nerve stimulator. The ease of block, success rate (number of attempts to accomplish the block) and complications were noted and compared between both the approaches. Chi-square analysis was performed to compare the ease of approach of the two techniques. Non-parametric analyses using Mann Whitney test was used to compare the number of attempts to accomplish the block in each approach. A value of P < 0.05 was considered statistically significant.
The ease of block (P = 0.09) and the median number of attempts to accomplish the block (P = 0.45) were comparable between the two approaches. The incidence of vascular injury was higher in classic approach (P = 0.056).
Inguinal approach is a useful alternative to classic approach block for patients undergoing TURBT under SA.
选择性闭孔神经阻滞（ONB）是预防脊髓麻醉（SA）下经尿道膀胱肿瘤切除术（TURBT）累及侧壁时内收肌痉挛的有效方法。经典方法不太受欢迎，因为闭孔神经位置较深且与血管损伤有关。腹股沟入路被描述为一种更安全的替代方法。本随机临床研究旨在比较经典耻骨入路和浅表腹股沟入路进行ONB的阻滞难易程度、成功率及并发症。
总共30例计划在SA下接受TURBT的患者接受双侧ONB。使用神经刺激器，一侧采用Choquet最近描述的腹股沟入路，另一侧采用Labat描述的经典入路，顺序随机。记录并比较两种入路的阻滞难易程度、成功率（完成阻滞的尝试次数）及并发症。采用卡方分析比较两种技术的入路难易程度。使用Mann Whitney检验进行非参数分析，以比较每种入路完成阻滞的尝试次数。P值<0.05被认为具有统计学意义。
两种入路的阻滞难易程度（P = 0.09）和完成阻滞的中位尝试次数（P = 0.45）相当。经典入路的血管损伤发生率更高（P = 0.056）。
对于在SA下接受TURBT的患者，腹股沟入路是经典入路阻滞的一种有用替代方法。
