Effect Of Lidocaine In Different Concentrations On Preventing Obturator Nerve Reflex During TURBT Surgery

Objective:This experiment was conducted to investigate the effects of local anesthetic concentration on the prevention of obturator nerve reflex and adductor muscle movement changes during perioperative tranurethral bladder tumor resection using 1%,1.25% and 1.5% lidocaine 10 ml obturator nerve block under ultrasound guidance.Methods:Forty-five patients,ASA GRADE I or ⅱ,aged between 40 and 75 years,were selected for selective transurethral resection of tumors on the posterior wall of the bladder under ultrasound guided obturator nerve block combined with static aspiration and general anesthesia,and the expected operation time was ≤0.5h.Patients were randomly divided into group A（1% lidocaine 10ml）,group B（1.25% lidocaine 10ml）and group C（1.5% lidocaine 10ml）,with 15 patients in each group.After entering the room,patients in the three groups received obturator nerve block with different concentrations of lidocaine,and general anesthesia induction was started 15 min after the block was successful.In this experiment,general anesthesia without muscle relaxants was used,followed by intravenous injection of midazolam 0.05 mg/kg,sufentanil 0.4μg/kg,etomidate 0.2mg/kg,and propofol 2.5mg/kg,and placed into the corresponding model of laryngeal mask,connected to the anesthesia machine for mechanical ventilation.During the operation,the inhalation anesthetic sevoflurane combined with remifentanil pump was used for anesthesia maintenance,and no muscle relaxation drugs were used during the whole anesthesia process to ensure the accuracy of the experimental results.Sufentanil was added for hemodynamic instability and recorded.By observing the three groups of patients in the operation time,presence of body movement and bladder injury judging obturator nerve block effect,and compared in 30 min of three groups of patients with adduction muscle movement inhibit recovery,record three groups of patients with local anesthetics adverse reactions such as the occurrence of the event,such as puncture hematoma,groin pain,obturator nerve dominate regional paresthesia,etc.Results:No significant differences in gender,age,height,weight and BMI among the three groups（P > 0.05）.The intraoperative body movement of the three groups was statistically significant（P=0.014）,and compared with group B and group C,the number of patients with no adductor contraction during operation in group A was significantly less than the above two groups,and the clinical effective rate was lower with statistical difference.However,there were no adverse events of bladder injury in all three groups.After the operation,the recovery of adductor muscle strength 30 minutes after operation was compared among the three groups,and there was no significant statistical difference（P > 0.05）.Compared with group C,there were significantly more patients in group A and group B with complete recovery of adductor muscle movement,with statistical significance（P < 0.05）.The incidence of related adverse events was low in all three groups,and the difference was not statistically significant（P< 0.05）.Conclusion:The use of 1.25% and 1.5% 10 ml lidocaine for obturator nerve block under ultrasound guidance can effectively prevent obturator nerve reflex during tranurethral bladder tumor resection,and 1.25% lidocaine may have less influence on early recovery of adductor muscle movement.