Mailuoning Compound for Treatment of Early Steroid-induced Osteonecrosis of Femoral Head in Rats by Obturator Nerve Block / 中国实验方剂学杂志

Objective: To investigate the effect and mechanism of Mailuoning Compound for treatment of early steroid-induced osteonecrosis of femoral head (SONFH) in rats by obturator nerve block. Method: 24 rats were injected with endotoxin 10 μg·kg-1 through tail vein. After 24 hours, prednisolone acetate 20 mg·kg-1 was given by intraperitoneal injection, once every 24 hours for 3 consecutive days. After successful modeling, the rats were randomly divided into the model group (n=12), the treatment group (n=12) and the normal control group (n=6). In the treatment group, 2 mL·kg-1 of Mailuoning compound was injected into the obturator nerve from the 4th day, 3 times a week for 8 weeks. The arterial blood was collected from rats on the first day of the 9th week after model building to detect the content of blood lipid; the femoral head was taken to prepare the paraffin section, and the pathological changes of femoral head was observed and the changes of empty bone lacuna rate, bone trabecular area and bone lacuna area were quantitatively analyzed; The changes of bone morphogenetic proteins(BMPs),transforming growth factor-β1(TGF-β1),vascular endothelial cell growth factor(VEGF),and Ⅷ factor related antigen(Ⅷ-R Ag) were quantitatively analyzed by immunohistochemical method. Result: In the model group, the bone trabeculae were sparse, thin, disorganized and broken; some of the bone cells were necrotic and the number of empty bone lacunae was increased. In the treatment group, the number of trabeculae was increased; the structure was clear, most of which was normal bone cells, with a few necrotic bone cells, and the number of empty bone lacunae was decreased obviously. The rate of empty bone lacuna and the area of bone lacuna in the treatment group were significantly lower than those in the model group (Pβ1 and the microvessel density of Ⅷ-R Ag in the treatment group were significantly higher than those in the model group (PPConclusion: Mailuoning compound can improve the microcirculation state of femoral head, promote the formation of new bone and blood vessel in femoral head by regulating the expression of VEGF, BMPs, TGF-β1, Ⅷ-R Ag and down-regulating blood lipid content, thus effectively controlling the development of early SONFH. This can provide a theoretical basis for the treatment of early SONFH.

Effect of ultrasound-guided obturator nerve block in prevention of obturator nerve reflex in transurethral resection of bladder tumor / 临床麻醉学杂志

Objective Comparing obturator nerve reflex in different anesthesia,to investigate the incidence of obturator nerve reflex in transurethral resection of bladder tumor.Methods A total of 160 patients with lateral wall of bladder tumors were included,who required a TURBT,were randomly divided into four groups:general anesthesia group (group G),combined spinal-epidural anesthesia group (group C),combined spinal-epidural anesthesia compounding intravenous anesthesia group (group V),combined spinal-epidural anesthesia compounding obturator nerve block group (group O),n =40 in each group.The incidence of obturator nerve reflex was recorded.Results Incidence of obturator nerve reflex in group O (7.5％) was lower than in group C (32.5％,P=0.005) and group V (40.0％,P=0.001).There was no significant difference between group G (5.0％) and group O (P =0.644).Conclusion Both combined spinal-epidural anesthesia with obturator nerve block and general anesthesia can effectively prevent obturator nerve reflex.

Clinical research on the effect of the obturator nerve block guided by ultrasound combined with nerve stimulation / 临床麻醉学杂志

Objective Comparing the effects of ultrasound with nerve stimulation guided obtu-rator nerve block(ONB)with simple nerve stimulation guided ONB for transurethral resection of blad-der tumor(TURBT),so as to realize the validity and advantages of ultrasound with nerve stimulation guided ONB.Methods Sixty ASA Ⅰ or Ⅱ,male or female,age 39-77 years old,BMI 1 9-30 kg/m2 patients undergoing elective TURBT were randomly divided into two groups,nerve stimulation group (group S)and ultrasound and nerve stimulation group (group US).Success rate of the first puncture, visual analog scale (VAS)pain score,insertion-adductor contraction interval (ICI),puncture times corresponding to ICI,adductor strength,incidence of complications and validity were observed during and after ONB.Results There was no significant difference of the general validity,adductor strength and complication incidence between the two groups.The success rate of the first puncture was signifi-cantly higher in group US than that in group S (P < 0.01).VAS pain score,ICI and puncture times were significantly lower in group US than those in group S (P < 0.05).Conclusion Compared with simple nerve stimulation guided ONB,ultrasound with nerve stimulation guidance showed less punc-ture time,more accurate positioning and more comfort.

Obturator Nerve Block Using Ultrasound-guided Intraneural Alcohol Injection in Patient with Hip Adductor Spasticity

OBJECTIVE: To investigate the effects of obturator nerve blocks with ultrasound guided intraneural alcohol injection. METHOD: Nine quadriplegic patients suffering hip adductor spasticity were included in this study. The obturator nerve was identified at just below inguinal ligament area on anteromedial surface of upper leg at supine position. An 23 G needle was inserted into anterior branch of obturator nerve under real time ultrasonography. The 50% alcohol solution was injected 3~5 ml at a time within the epineurium of the anterior branch of obturator nerve until the expanding nerve was visualized. We examed modified Ashworth scale (MAS) of hip adductor and passive range of movement of hip abduction at supine position at study entry, 1, 4, and 12 weeks after ultrasound guided intraneural injection. RESULTS: There were statistically significant improvement was seen in MAS of hip adductors and hip abduction angle at 1, 4, and 12 weeks after ultrasound guided intraneural injection, compared with parameters measured at previous injection (p<0.05). CONCLUSION: Ultrasound guided intraneural alcohol injection into anterior branch of obturator nerve for treatment of hip adductor spasticity in patients with quadriplegia is an effective and safe procedure for relieving localized spasticity of the hip adductors.

Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB / 대한마취과학회지

BACKGROUND: During transurethral resection of bladder tumors (TURB) under spinal anesthesia, electrical resection of the lateral wall mass may cause violent adductor contraction and possible inadvertent bladder perforation. Therefore, obturator nerve block (ONB) is mandatory after spinal anesthesia to avoid adductor muscle contraction. We compared the success rate and efficacy of an inguinal approach, to a pubic approach for ONB. METHODS: One hundred and two patients who required ONB undergoing TURB with spinal anesthesia were included in this study. After spinal anesthesia, ONB was performed with an inguinal approach (Group I, n = 51) or pubic approach (Group P, n = 51) using a nerve stimulator. In the pubic approach, a needle was inserted at a point 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle. For the inguinal approach, a needle was inserted at the midpoint of the femoral artery and the inner margin of the adductor longus muscle 0.5 cm below the inguinal crease. If the adductor contracture had not occurred by the 3rd attempt, it was defined as a failed block. Puncture frequency, success rate, anatomical characteristics, and the presence of adductor muscle contraction during operation were evaluated. RESULTS: The success rate of ONB was higher in group I compared to group P (96.1% vs. 84.0%, P = 0.046) and the frequency of needle attempts was lower in group I than in group P (1.8 +/- 0.9 vs. 1.3 +/- 0.6, P = 0.01). CONCLUSIONS: The inguinal approach for ONB appears to be technically easier and offers certain anatomical advantages when compared to the pubic approach.

Ultrasound Guided both Obturator Nerve Block for Patient with Adductor Thigh Muscle Spasm : A case report

Obturator nerve block has been used for analgesia of hip pain, relaxation of adductor muscle spasm related to cerebral palsy or paraplegia and in urologic surgery to prevent inadvertent obturator activity during lateral wall cystoscopy. Recently, ultrasound guidance has gained popularity in the field of peripheral nerve block and have been reported in some benefits. We describe here successfully performed both obturator nerve block under ultrasound guidance.

Inadvertent Breakage of the Spinal Needle during the Obturator Nerve Block for the Transurethral Resection of Bladder Tumor: A case report / 대한마취과학회지

Obturator nerve block is occasionally performed during transurethral resection of lateral bladder wall tumors to prevent the violent contraction of the adductor muscle of the thigh. Rare complications including intravascular injection of the local anesthetics and hematoma formation may occur during the obturator nerve block. We report a case of the unintentional breakage of the spinal needle during the obturator nerve block with successful removal of the broken spinal needle by an orthopedic surgeon.

Use of Nerve Stimulator for the Obturator Nerve Block / 대한마취과학회지

BACKGROUND: The obturator nerve passes in close proximity to the inferolateral bladder wall. Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective to stop adductor spasm during spinal anesthesia. The use of nerve stimulator for the obturator nerve block is simple and well described. We investigated the dosage of local anesthetics and the depth of skin to nerve in obturator nerve block using nerve stimulator. METHODS: We performed obturator nerve block in 87 cases by use of spinal needle and nerve stimulator, and measured the intensity of stimulation, the dosage of local anesthetics and the depth of the skin to the obturator nerve. RESULTS: The overall success rate of obturator nerve block was 95.4%. Body Mass Index (BMI) was positively correlated with the depth of skin to the obturator nerve. However, no correlation was found between BMI and the intensity of stimulation. The dosage of local anesthetics was 198.6 +/- 7.3 mg of lidocaine. The depth of the skin to nerve was 60 +/- 12 mm in men, 54 +/- 11 mm in women. CONCLUSIONS: Use of nerve stimulator for obturator nerve block is accurate, and safe. BMI was positively correlated with the depth of the obturator nerve.

Clinical application of the peripheral stimulation in the obturator nerve block used in the TURBt / 肿瘤研究与临床

Objective Observe the results and reality of the peripheral nerve stimulator in the obtu- rator nerve block in TURBt.Methods 18 cases received the peripheral nerve stimulator in obturator nerve block before TURBt.Results In 17cases obturator nerve reflection vanished;lcase had a little symptom of adductor spasm.Conclusion Obturator nerve block with the help of the nerve stimulator can increase the achievement and quality of obturator nerve block and avoid some complications caused by obturator nerve re- flection in TURBt,such as perforation of bladder and injury of nerve and vessel.

Prevention of Obturator Nerve Reflex during Transurethral Surgery of Bladder Tumor / 대한비뇨기과학회지

Adductor contraction from obturator nerve stimulation occurs frequently in certain situations during transurethral operations. Bladder perforation is a common result. A simple and safe technique involving use of a nerve stimulator for accurate obturator blockade and psoas compartment block are described. Only one of seven cases has obturator nerve stimulation after psoas compartment block. But there were no adductor contractions in more than seventeen transurethral resections during one year interval. There were no complications from the block itself or use of the nerve stimulator. Herein we introduce these safe methods for prevention of obturator nerve stimulation during transurethral resection.