Department of Anesthesiology and Intensive Care, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
Department of Orthopedics, National Academy of Medical Sciences, National Trauma Centre.
J Nepal Health Res Counc. 2023 Jul 20;20(4):998-1002. doi: 10.33314/jnhrc.v20i4.4523.
Urinary bladder cancer is more common in geriatric population. Transurethral resection of bladder tumor remains the mainstay of treatment. It is usually performed under subarachnoid block. However, obturator nerve is spared in subarachnoid block that can produce adductor jerk, which is associated with bladder injury, rupture, incomplete resection of tumor and hematoma. To overcome this jerk, selective obturator nerve block is commonly performed. Thus, we conducted this study to compare the efficacy of ultrasound and nerve stimulator-guided techniques for obturator nerve block.
This is a prospective, comparative study conducted at a tertiary care hospital in Nepal. Sixty patients, scheduled to undergo Transurethral Resection of Bladder Tumor for lateral and posterolateral wall bladder cancer under subarachnoid block were enrolled and divided into two group having thirty patients in each groups. Group I received 15 ml of 0.25% Bupivacaine to block obturator nerve by using peripheral nerve stimulator. Group II received the same amount of Bupivacaine to block obturator nerve under ultrasound guidance. We evaluated the success of the block, ease of the procedure and complications.
The adductor reflex was present in 23.33% of cases with nerve stimulator guided obturator nerve block, whereas, it was16.66% in ultrasound guided technique (p=0.75). The success rate of obturator nerve block was 76.66% in nerve stimulator guided technique, whereas 83.33% in ultrasound guided technique (p= 0.21). 83.33% of obturator nerve block was found to be easy in nerve stimulator guided technique, whereas 66.66 % in ultrasound guided technique (p = 0.14). There were no major complications noted.
The findings of this study conclude that both ultrasound and nerve stimulator guided techniques equally abolished the adductor reflexes. Both techniques are easy to perform and safe.
膀胱癌在老年人群中更为常见。经尿道膀胱肿瘤切除术仍然是主要的治疗方法。它通常在蛛网膜下腔阻滞下进行。然而，蛛网膜下腔阻滞会避开闭孔神经，从而产生内收肌反射，这与膀胱损伤、破裂、肿瘤不完全切除和血肿有关。为了克服这种反射，通常会进行选择性闭孔神经阻滞。因此，我们进行了这项研究，比较了超声和神经刺激器引导技术在闭孔神经阻滞中的效果。
这是在尼泊尔一家三级保健医院进行的前瞻性、对照研究。纳入了 60 名计划在蛛网膜下腔阻滞下接受经尿道膀胱肿瘤切除术治疗侧壁和后侧壁膀胱癌的患者，并将其分为两组，每组 30 名患者。第 I 组通过外周神经刺激器给予 15ml0.25%布比卡因阻滞闭孔神经。第 II 组在超声引导下给予相同剂量的布比卡因阻滞闭孔神经。我们评估了阻滞的成功率、操作的简便性和并发症。
神经刺激器引导的闭孔神经阻滞中，内收肌反射的出现率为 23.33%，而超声引导技术的出现率为 16.66%（p=0.75）。神经刺激器引导技术的闭孔神经阻滞成功率为 76.66%，而超声引导技术的成功率为 83.33%（p=0.21）。神经刺激器引导技术中 83.33%的闭孔神经阻滞被认为是容易的，而超声引导技术中 66.66%的闭孔神经阻滞是容易的（p=0.14）。没有发现主要并发症。
本研究的结果表明，超声和神经刺激器引导技术同样可以消除内收肌反射。两种技术都易于操作且安全。
