一项前瞻性随机对照试验，比较耻骨肌下与筋膜间闭孔神经阻滞技术在经尿道膀胱肿瘤切除术中预防内收肌痉挛的效果。
完整摘要 · 中文译文
背景：闭孔神经阻滞（ONB）常用于预防涉及侧壁病变的经尿道膀胱肿瘤切除术（TURBT）中的内收肌痉挛。本研究旨在比较超声引导下耻骨肌下（近端）与筋膜间（远端）ONB 技术的临床有效性和安全性，采用根据目标筋膜间隙调整的个体化给药方案。 方法：这项前瞻性随机对照试验纳入了 60 例计划在蛛网膜下腔麻醉下行择期 TURBT 的患者。患者被随机分为两组：耻骨肌下 ONB 组（I 组，n = 30），在单一耻骨肌下平面内单次注射 10 mL 0.375% 布比卡因；筋膜间 ONB 组（II 组，n = 30），将总量 20 mL 的 0.375% 布比卡因分为两次各 10 mL 的注射，用于两个不同的筋膜间平面。术中内收肌痉挛由一位设盲的外科医生采用 4 级量表（I-IV 级）进行评估。主要结局指标为阻滞成功率，定义为未发生需要补救性全身麻醉的严重痉挛（IV 级）。 结果：两组之间的基线人口学特征和穿刺次数相似。未发生血管穿刺、血肿或膀胱穿孔。两组描述性阻滞成功率均较高，I 组达到 86.7%（95% 置信区间：74.6% 至 98.8%），II 组达到 93.3%（95% 置信区间：84.4% 至 100%），差异无统计学意义（p = 0.67）。 1). 结论：在采用根据解剖结构定制的给药方案时，两种超声引导的闭孔神经阻滞技术均显示出很高的描述性临床成功率。尽管由于样本量限制，不显著的 p 值须谨慎解读，但两种方法都为侧壁经尿道膀胱肿瘤切除术中预防严重内收肌痉挛提供了可行且有效的选择。试验注册：ClinicalTrials.gov 标识符：NCT07481123（于 2026 年 3 月 2 日回顾性注册）。
完整摘要 · 英文原文
BACKGROUND: Obturator nerve block (ONB) is commonly used to prevent adductor muscle spasm during transurethral resection of bladder tumors (TURBT) involving lateral wall lesions. This study aimed to compare the clinical effectiveness and safety of ultrasound-guided subpectineal (proximal) and interfascial (distal) ONB techniques, utilizing an anatomically tailored dosing regimen adapted to the targeted fascial compartments. METHODS: This prospective randomized controlled trial included 60 patients scheduled for elective TURBT under spinal anesthesia. Patients were randomly allocated into two equal groups: subpectineal ONB (Group I, n = 30), which received a single 10 mL bolus of 0.375% bupivacaine into the single subpectineal plane, and interfascial ONB (Group II, n = 30), which received a total of 20 mL of 0.375% bupivacaine split into two separate 10 mL injections for the two distinct interfascial planes. Intraoperative adductor muscle spasm was evaluated by a blinded surgeon using a 4-grade scale (Grades I-IV). The primary outcome was the block success rate, defined as the absence of severe spasm (Grade IV) requiring rescue general anesthesia. RESULTS: Baseline demographic characteristics and the number of needle insertions were similar between the groups. No vascular puncture, hematoma, or bladder perforation occurred. The descriptive block success rate was high in both groups, reaching 86.7% (95% Confidence interval: 74.6% to 98.8%) in Group I and 93.3% (95% Confidence Interval: 84.4% to 100%) in Group II, with no statistically significant difference observed (p = 0.671). CONCLUSIONS: Both ultrasound-guided ONB techniques demonstrate high descriptive clinical success rates when utilizing an anatomically tailored dosing regimen. Although the non-significant p-value must be interpreted with caution due to sample size limitations, both approaches provide viable and effective options for preventing severe adductor muscle spasm during lateral wall TURBT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07481123 (retrospectively registered on 02 March 2026).