Department of Anesthesiology, North Florida/Southern Georgia Veterans Health System and the University of Florida, Gainesville, Florida, USA.
Central Florida Pain Management (Physical Medicine and Rehabilitation), Ocala, Florida, USA.
Pain Med. 2021 Jun 4;22(6):1253-1260. doi: 10.1093/pm/pnaa448.
The obturator nerve runs along the posterolateral walls of the bladder and electrosurgical stimulation in this region can result in adductor spasm which can occur suddenly and unexpectedly with potentially catastrophic results.
Sixty patients were prospectively randomized to receive either a single-injection ultrasound-guided obturator nerve block (ONB) or intravenous rocuronium after induction of general anesthesia (i.e., neuromuscular block [NMB]). The primary objective was to compare the incidence of adductor spasm during posterolateral bladder tumor resection when ONB or NMB was used. Secondary objectives included assessment of fall risk and incidence of adverse events.
Five patients in the ONB group and six in the NMB group had nonlateral wall lesions. One patient in the ONB group suffered a cardiac arrest after induction of general anesthesia. Of the remaining 48 patients, six (10.2%) experienced adductor spasm. Most of these patients were in the NMB group (5/24, 20.8%), with only one patient (1/24, 4.2%) experiencing obturator reflex in the ONB group; this difference was not statistically significant (P=0.19). Patients in the ONB group had a greater decrease in mean hip adductor strength. Our study population was found to be at high risk of falls before surgery. There were no statistically significant group differences in the Timed Up and Go test, with time to perform the test increasing in both groups.
Both techniques are safe and efficacious for preventing adductor spasm. Our data and experience suggest that the ONB is relatively easy to perform and should be considered in patients with posterolateral bladder tumors.
闭孔神经沿着膀胱的后外侧壁运行，在该区域进行电外科刺激会导致内收肌痉挛，这种痉挛可能突然且意外发生，导致潜在的灾难性后果。
60 名患者前瞻性随机分为单次注射超声引导闭孔神经阻滞（ONB）组或全身麻醉诱导后静脉注射罗库溴铵（即神经肌肉阻滞[NMB]）组。主要目的是比较在使用 ONB 或 NMB 时，在后外侧膀胱肿瘤切除术中发生内收肌痉挛的发生率。次要目标包括评估跌倒风险和不良事件的发生率。
ONB 组中有 5 名患者和 NMB 组中有 6 名患者患有非侧壁病变。ONB 组中有 1 名患者在全身麻醉诱导后发生心脏骤停。在其余 48 名患者中，有 6 名（10.2%）发生内收肌痉挛。这些患者大多在 NMB 组（24 例中的 5 例，20.8%），只有 1 例（24 例中的 1 例，4.2%）在 ONB 组中出现闭孔反射；这种差异无统计学意义（P=0.19）。ONB 组患者的平均髋关节内收肌力量下降更大。我们的研究人群在手术前有很高的跌倒风险。在计时起立行走测试中，两组之间的测试时间都有所增加，但组间差异无统计学意义。
这两种技术在预防内收肌痉挛方面都是安全有效的。我们的数据和经验表明，ONB 相对容易实施，对于后外侧膀胱肿瘤患者应考虑使用。
