Guney Ihsan, Argun Guldeniz
Department of Anesthesiology and Reanimation, Adana City Training and Research Hospital, Adana, TUR.
Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, TUR.
Cureus. 2022 Feb 18;14(2):e22365. doi: 10.7759/cureus.22365. eCollection 2022 Feb.
During transurethral resection of bladder tumor (TUR-BT), adductor muscle spasms in varying degrees can be seen due to stimulation of obturator nerve if the tumor is in the inferolateral localization. This can cause some serious complications such as bladder perforation. We aim to show the effectiveness of obturator nerve block (ONB) to avoid the adductor muscle spasm in general anesthesia applied with laryngeal mask (LMA) without using muscle relaxant according to the spinal anesthesia method.
The study has been designed prospectively and observationally. A total of 64 patients who underwent TUR-BT were divided into two groups. Group I consisted of 30 patients in whom TUR-BT was performed under general anesthesia without muscle relaxant + ONB. Group II consisted of 31 patients in whom TUR-BT was performed under spinal anesthesia + ONB. Intraoperative adductor spasm, the severity of adductor response, and surgeon satisfaction were recorded.
Median values of adductor muscle strengths were found to be higher in Group I (p < 0.05). There was no statistically significant relationship between the anesthetic method and adductor spasm (p = 0.110). Of patients in Group I, 13.4% showed moderate or severe adductor response, whereas the ratio was 0% in Group II (p = 0.015). Surgeon satisfaction was similar in both groups (p = 0.363).
Obturator spasm was not different in both anesthesia techniques. General anesthesia without muscle relaxant combined with ONB was found effective to prevent adductor muscle spasms as the spinal anesthesia in TUR-BT operations. It has been concluded that surgical complications can be reduced via general anesthesia without the muscle relaxant method, although surgeons' satisfaction did not alter. General anesthesia and obturator block applications with the help of LMA without muscle relaxants can be preferred in short-term TUR-B operations where spinal anesthesia is not desired.
在经尿道膀胱肿瘤切除术（TUR - BT）中，如果肿瘤位于膀胱下外侧，因闭孔神经受刺激可出现不同程度的内收肌痉挛。这可能导致一些严重并发症，如膀胱穿孔。我们旨在表明，按照脊髓麻醉方法，在使用喉罩（LMA）的全身麻醉中，不使用肌肉松弛剂时，闭孔神经阻滞（ONB）可有效避免内收肌痉挛。
本研究为前瞻性观察性设计。总共64例行TUR - BT的患者被分为两组。第一组由30例在无肌肉松弛剂的全身麻醉 + ONB下进行TUR - BT的患者组成。第二组由31例在脊髓麻醉 + ONB下进行TUR - BT的患者组成。记录术中内收肌痉挛情况、内收肌反应的严重程度以及外科医生的满意度。
发现第一组内收肌力量的中位数较高（p < 0.05）。麻醉方法与内收肌痉挛之间无统计学显著关系（p = 0.110）。第一组患者中，13.4%表现出中度或重度内收肌反应，而第二组这一比例为0%（p = 0.015）。两组外科医生的满意度相似（p = 0.363）。
两种麻醉技术下闭孔肌痉挛情况无差异。发现在TUR - BT手术中，无肌肉松弛剂的全身麻醉联合ONB与脊髓麻醉一样，对预防内收肌痉挛有效。得出结论，尽管外科医生的满意度未改变，但通过无肌肉松弛剂的全身麻醉方法可减少手术并发症。在不希望采用脊髓麻醉的短期TUR - B手术中，可优先选择借助LMA且不使用肌肉松弛剂的全身麻醉和闭孔神经阻滞应用。
