Muwal Simmi, Singh Meena Dharam, Gupta Arushi
Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Anesthesiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Cureus. 2024 Jan 27;16(1):e53062. doi: 10.7759/cureus.53062. eCollection 2024 Jan.
Background This study aimed to compare ultrasound versus ultrasound with nerve stimulation-guided obturator nerve block (ONB) for the prevention of adductor spasm in patients undergoing transurethral resection of bladder tumor (TURBT). Methodology This randomized controlled study included 240 adult patients in the age group of 30 to 70 years undergoing TURBT for lateral and posterolateral wall bladder tumors who fulfilled the American Society of Anesthesiologists grade I and II criteria. The patients were divided into two groups: group U (n = 120) included patients who underwent ONB using an ultrasound-guided technique and group UN (n = 120) included patients who underwent ONB using ultrasound with the nerve stimulation technique. Block performance time, adductor jerks/spasms, adductor muscle power, and patient and surgeon satisfaction were compared. A P-value <0.05 was considered statistically significant. Results The mean block performance time in group U was significantly less (4.4 ± 0.82 minutes) than in group UN (6.55 ± 0.37 minutes). Compared to group U, group UN had significantly fewer adductor jerks/spasms during the surgery (7.76% vs. 20.35%, p = 0.006), significantly more surgeon satisfaction (92.24% vs. 79.65%, p = 0.006), significantly more patient satisfaction (92.24% vs. 79.65%, p = 0.006), and comparable complications (excessive bleeding and minor bladder injury) and adductor muscle power after the block (p > 0.05). Conclusions ONB using the nerve stimulation technique under ultrasound guidance has a longer mean block performance time, a higher success rate, and higher surgeon satisfaction than ONB under ultrasound guidance only.
背景 本研究旨在比较超声引导与超声联合神经刺激引导闭孔神经阻滞（ONB）在经尿道膀胱肿瘤切除术（TURBT）患者中预防内收肌痉挛的效果。方法 这项随机对照研究纳入了240例年龄在30至70岁之间、因膀胱侧壁和后外侧壁肿瘤接受TURBT且符合美国麻醉医师协会I级和II级标准的成年患者。患者被分为两组：U组（n = 120）包括采用超声引导技术进行ONB的患者，UN组（n = 120）包括采用超声联合神经刺激技术进行ONB的患者。比较两组的阻滞操作时间、内收肌抽搐/痉挛情况、内收肌肌力以及患者和外科医生的满意度。P值<0.05被认为具有统计学意义。结果 U组的平均阻滞操作时间（4.4±0.82分钟）显著短于UN组（6.55±0.37分钟）。与U组相比，UN组在手术期间内收肌抽搐/痉挛明显更少（7.76%对20.35%，p = 0.006），外科医生满意度显著更高（92.24%对79.65%，p = 0.006），患者满意度也显著更高（92.24%对79.65%，p = 0.006），且两组的并发症（出血过多和轻微膀胱损伤）以及阻滞后的内收肌肌力相当（p>0.05）。结论 超声引导下使用神经刺激技术的ONB比单纯超声引导下的ONB平均阻滞操作时间更长、成功率更高且外科医生满意度更高。
