超声联合神经刺激器行闭孔神经阻滞在膀胱肿瘤电切术中的应用

目的观察超声联合神经刺激器行闭孔神经阻滞在经尿道膀胱肿瘤电切术中预防闭孔神经反射的临床效果及并发症。方法选经尿道膀胱肿瘤电切术患者60例，随机分为2组：超声引导闭孔神经阻滞组（U组，30例），超声联合神经刺激器闭孔神经阻滞组（U＋S组，30例）。观察闭孔神经阻滞后5、10、15min后内收肌收缩情况，记录运动阻滞起效时间，操作时间，麻醉相关时间，穿刺次数，15rain时阻滞成功率。结果U＋S组与U组相比运动阻滞起效时间没有明显差异（7．7vs6．4min，P=0．232），U＋S组操作时间比S组长（3．1vs1．7min，P〈0．001），麻醉相关时间两组无差异（U＋S组9．8rain，S组8．6min，P=0．68），穿刺次数两组无差异（U＋S组2．4min，S组2．1min，P=0．28），15min时U＋S组与U组相比阻滞成功率高（100％比80％，P=0．04）。结论超声联合神经刺激器行闭孔神经阻滞功率高，可以安全、有效的预防膀胱肿瘤电切术闭孔神经反射。

Clinical Application of the Obturator Nerve Block Under Ultrasound Combined Neurostimulation in the TURBT.

Objective To evaluate the effectiveness of the approach for obturator nerve under blockuhrasound combined neurostimulation in transurethral resection of the bladder tumor （TURBT）. Methods Sixty spinal anesthesia patients who had ex- perienced unilateral adduetor muscle spasm during transurethral bladder tumor resection were randomly allocated to receive either 5 mL of lidocaine 2% injected under ultrasound guidance into the interfascial plane between the adductor longus and the adductor brevis and between the adductor brevis and the magnus muscles （ U group） or an injection of 5 mL of lidocaine 2% in combination with nerve stimulation after identification of the divisions of the obturator nerve （ U ＋ S group）. At 5, 10, and 15 minutes after block placement, muscle spasm was assessed by an independent observer masked to treatment allocation. The primary outcome was motor block onset time. Secondary outcomes were block performance time, total anesthesia-related time, motor block success at 15 minutes, and number of needle passes. Results Motor block onset time did not differ between the 2 groups （6. 4 minutes for U versus 7.7 minutes for US group, P = 0. 232）, block performance time was longer in the U ＋ S than in the U group （3. lminutes versus 1.7 minutes, P 〈 0. 001 ）, and total anesthesia-related time did not differ between the 2 groups （9. 8 minutes versus 8.6 minutes, P = 0. 68）. Block success rate at 15 minutes was 100% in the U ＋ S group and 80% in the US group （ P = 0.04）. There was no difference in the number of needle passes （2. 4minutes versus 2. 1 minutes, P = 0. 28 ）. Conclusion The safety and efieacy can be warranted when obturator nerve block technique is performed under ultrasound combined neurostimulation and has a prospect be widely used in TURBT.