ABSTRACT
PURPOSE: This study was conducted to evaluate whether the ultrasound-guided interfascial injection technique is really compatible with the ultrasound-guided nerve stimulating technique for obturator nerve block (ONB) at the inguinal crease after bifurcation of the obturator nerve. MATERIALS AND METHODS: A total 62 ONBs were performed for transurethral resection of bladder tumors under spinal anesthesia, and divided into two groups, that is, to an ultrasound-guided ONB with nerve stimulation control group (the US-NS group) or an ultrasound-guided interfascial injection experimental group (the US-IFI group). In the US-IFI group, complete ONB was confirmed using a nerve stimulator at 5 min after completing the injection, and if residual twitching remained, another local anesthetic was injected; in such cases blocks were considered to have 'failed'. During TURB surgeries, two urology assistants determined obturator reflex grade (I-IV) at 15 min after injection completion in both groups. RESULTS: We assumed that the US-NS group achieved complete ONB in all cases. Six cases in the US-IFI group failed to achieve complete ONB (failure rate: 0% versus 19.4%, P = .012). There was one case of grade II obturator reflex in each group. CONCLUSION: The ultrasound-guided interfascial injection technique was not compatible with the ultrasound-guided nerve stimulating technique for ONB at the inguinal crease.
Subject(s)
Anesthesia/methods , Electric Stimulation Therapy/methods , Nerve Block/methods , Obturator Nerve , Ultrasonography, Interventional/methods , Urinary Bladder Neoplasms/surgery , Aged , Aged, 80 and over , Cystectomy , Fascia , Female , Humans , Injections , Male , Middle AgedABSTRACT
Spinal cord stimulation (SCS) is highly successful for treating neuropathic pain but its effect is limited for central origin pain caused by cord injury. The authors describe a case in which pain was successfully controlled by SCS implantation in a patient with intractable chronic neuropathic pain after T5 meningioma removal. The authors tried lead insertion over the T5 level passing through postoperative adhesions to produce adequate stimulation to the patient's painful areas fully enough without any complications. This case showed good response to SCS even though it was a central type of neuropathic pain by spinal cord injury.