Sharma Deepak, Singh V P, Agarwal Nidhi, Malhotra M K
Department of Anesthesiology and Critical Care, Subharti University, Meerut, Uttar Pradesh, India.
Anesth Essays Res. 2017 Jan-Mar;11(1):101-104. doi: 10.4103/0259-1162.184613.
Sparing of obturator nerve is a common problem encountered during transurethral resection of bladder tumor (TURBT) under spinal anesthesia.
To evaluate and compare obturator nerve block (ONB) by two different techniques during TURBT.
This is prospective observational study.
Forty adult male patients from the American Society of Anesthesiologists Class I-IV planned to undergo TURBT under spinal anesthesia were divided into two groups of twenty each. In one group, ONB was performed with nerve locator. In other group, transvesical nerve block was performed with a cystoscope. The primary endpoints of this study were the occurrence of adductor reflex, ability to resect the tumor, and number of surgical interruptions. A number of transfusions required and bladder perforation were the secondary endpoints.
There was statistically significant difference between the groups for resection without adductor jerk, resection with a minimal jerk, and unresectable with high-intensity adductor jerk. Bleeding was observed in both groups and one bladder perforation was encountered.
We conclude that ONB, when administered along with spinal anesthesia for TURBT, is extremely safe and effective method of anesthesia to overcome adductor contraction. ONB with nerve locator appears to be more effective method compared to the transvesical nerve block.
在脊髓麻醉下经尿道膀胱肿瘤切除术（TURBT）过程中，闭孔神经损伤是一个常见问题。
评估和比较TURBT期间两种不同技术的闭孔神经阻滞（ONB）。
这是一项前瞻性观察研究。
40例计划在脊髓麻醉下接受TURBT的美国麻醉医师协会I-IV级成年男性患者被分为两组，每组20例。一组采用神经定位仪进行ONB。另一组采用膀胱镜进行经膀胱神经阻滞。本研究的主要终点是内收肌反射的发生、肿瘤切除能力和手术中断次数。所需输血次数和膀胱穿孔情况为次要终点。
两组在无内收肌抽搐切除、轻度抽搐切除和高强度内收肌抽搐无法切除方面存在统计学显著差异。两组均观察到出血，且出现1例膀胱穿孔。
我们得出结论，在TURBT中，ONB与脊髓麻醉联合使用时，是克服内收肌收缩的极其安全有效的麻醉方法。与经膀胱神经阻滞相比，使用神经定位仪进行ONB似乎是更有效的方法。
