To study the efficacy of Obturator Nerve blocks using nerve stimulator in Transurethral Resection of Bladder Tumor (TURBT) under spinal anaesthesia (original) (raw)
Related papers
2016
Sudden inadvertent occurrence of adductor muscle contraction during transurethral resection of bladder tumour operation under spinal anaesthesia is a common incidence, which may lead to various complications. Obturator nerve block is considered the most effective method to counteract these problems.The aim of this clinical study was to compare the ease of block, the success rate, failure rate and complications of the classic pubic and superficial inguinal approach for obturator nerve block under spinal anaesthesia for transurethral resection of bladder wall tumour. Patients and Methods: 50 patients of either sex, aged between 30 to 75 years with ASA physical status I & II, undergoing transurethral resection of bladder tumour operation were selected for the study.All 50 patients were given bilateral obturator nerve block using classic pubic approach on one side and the inguinal on the other side after performing spinal anaesthesia. The type
Bangladesh Journal of Urology, 2020
Introduction and aim of the study : Spinal anaesthesia for transurethral resection of bladder tumor (TURBT) does not prevent unintended stimulation of the obturator nerve when electro resection is performed on the lateral and Postero-lateral wall of the bladder. It results in muscle contraction of the adductor muscles of the thigh, which may lead to perforation of bladder wall with the resectoscope loop. The aim of the study was to compare the outcome of obturator nerve block by inguinal and transvesical approach. Materials and Methods: A prospective experimental study was done in the department of Urology Dhaka Medical College Hospital during the period of November 2016 to April 2018. Total 60 Patients were included for the study as per inclusion and exclusion Criteria. Patients were than allocated purposively into two groups by simple random sampling. Group A consisted of 30 patients where obturator nerve block (ONB) was done by transvesical approach and Group B also consisted of ...
Turkish journal of urology, 2017
To determine whether spinal anesthesia combined with obturator nerve blockade (SOB) is effective in preventing obturator nerve stimulation, jerking and bladder perforation during transurethral resection of bladder tumor (TURBT). In this clinical trial, 30 patients were randomly divided into two groups: spinal anesthesia (SA) and SOB. In SA group, 2.5 cc of 0.5% bupivacaine was injected intrathecally using a 25-gauge spinal needle and in SOB after spinal anesthesia, a classic obturator nerve blockade was performed by using nerve stimulation technique. There was a statistically significant difference between jerking in both groups (p=0.006). During the TURBT, surgeon satisfaction was significantly higher in SOB group compared to SA group (p=0.006). There was no significant correlation between sex, patient age and location of bladder tumor between the groups (p>0.05). Obturator nerve blockade by using 15 cc lidocaine 1% is effective in preventing adductor muscle spasms during TURBT.
Canadian Urological Association Journal, 2015
Introduction: In this prospective randomized controlled study, we investigated the efficacy of obturator nerve block (ONB) on adductor muscle spasm and related short-term outcomes and complications in patients who underwent transurethral resection of lateral wall-located bladder tumours (TURBT).Methods: Between July 2014 and February 2015, 70 patients scheduled to undergo TUR of lateral bladder wall tumours were enrolled in the study. All patients were preoperatively evaluated by cystoscopy and imaging tools and selected according to localized tumours on the lateral bladder wall. Patients were randomly allocated to Group SA (35 patients who underwent only spinal anesthesia) and Group ONB (35 patients who underwent spinal anesthesia combined with ONB by the nerve stimulator). An independent observer, blinded to the approach, evaluated the obturator signs, including adductor muscle contraction, bladder perforation, and completeness of the resection during the TURBT procedure.Results: ...
Journal of Anaesthesiology Clinical Pharmacology, 2014
Recently, Choquet et al., [7] described the inguinal approach, Background: Selective obturator nerve blockade (ONB) is an effective option to prevent adductor spasm during transurethral resection of bladder tumors (TURBT) involving the lateral wall under spinal anesthesia (SA). The classic approach is less popular as the obturator nerve is deep seated and associated with vascular injury. The inguinal approach was described as a safer alternative. This randomized clinical study was undertaken to compare the ease of block, the success rate and complications of the classic pubic and superficial inguinal approach for ONB. Materials and Methods: A total of 30 patients scheduled to undergo TURBT under SA were administered bilateral ONB. Inguinal approach recently described by Choquet was performed on one side and classic approach described by Labat was performed on the other side in random order using a nerve stimulator. The ease of block, success rate (number of attempts to accomplish the block) and complications were noted and compared between both the approaches. Chi-square analysis was performed to compare the ease of approach of the two techniques. Non-parametric analyses using Mann Whitney test was used to compare the number of attempts to accomplish the block in each approach. A value of P < 0.05 was considered statistically significant. Results: The ease of block (P = 0.09) and the median number of attempts to accomplish the block (P = 0.45) were comparable between the two approaches. The incidence of vascular injury was higher in classic approach (P = 0.056). Conclusions: Inguinal approach is a useful alternative to classic approach block for patients undergoing TURBT under SA.
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Bladder cancer is the ninth most commonly diagnosed cancer worldwide. The overall incidence has increased by 10% since last 30 years and 5 years survival rate by 50% in European countries.1 Transurethral resection of bladder tumor (TURBT) is the standard treatment given to the patients of superficial bladder tumors. During TURBT, local anatomical anesthesia may be given in order to block the obturator nerve thus avoiding the obturator jerk reflex. This study analyzes the surgical hazards in TURBT comparing blind versus nerve stimulator guided obturator nerve block with spinal block. Materials and Methods: A prospective randomized study was done in which 30 patients at HIMS and associated hospitals, were divided into three groups to compare the surgical hazards in TURBT comparing blind versus nerve stimulator guided obturator nerve block with spinal block. Results: 30 patients were included in this study. Mean operative time in Group 1(Obturator nerve block (ONB) during TURBT via blind technique) was 38 minutes, in Group 2 (ONB during TURBT via nerve stimulation technique) was 35 minutes and in group 3 (TURBT under spinal anesthesia only was 64 minutes. Effectiveness of blind technique of obturator nerve block (Group 1) in our study was 80% while that via nerve stimulator guided technique (Group 2) was 90%. Conclusion: This study indicates that use Obturator nerve block during TURBT via nerve stimulation technique is a better technique as compared to ONB during TURBT via blind technique. The use of nerve stimulator before ONB has better outcome. Keywords: Bladder spasm, Carcinoma, Obturator block, Spinal block, TURBT.
Obturator nerve block and transurethral surgery for bladder cancer
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 2007
The obturator nerve may be accidentally stimulated during transurethral resection of lateral bladder wall tumors, causing adductor spasms. In this study, we evaluated the results of obturator nerve block (ONB) produced via a blind anatomical approach. Between April 2004 and April 2006, 114 patients with bladder tumors located on the lateral bladder wall had undergone transurethral resection of the bladder tumor (TUR-BT) at our clinic. Sixty-three patients with adductor spasms received local anesthetic ONB; no adductor spasms were observed in the remaining 51 patients. ONB was obtained with 10 mL of 1% prilocaine infiltrated through a 22 G spinal needle using a blind anatomical approach. Two of the 63 patients were excluded from the study due to bladder wall perforations caused by adductor spasms. Successful ONB was performed unilaterally in 61 patients. Muscle spasms were absent in 59 of the 61 patients (97%). In 2 patients receiving spinal anesthesia, and in whom total resection of...
PubMed, 2019
Purpose: Obturator nerve block (ONB) has been performed in surgeries of transurethral resection of bladder tumors (TUR-BT) for the prevention of the development of obturator muscle contraction. Currently, classic and inguinal approaches are frequently being used. In the present study, we aimed to compare the success rate, performance speed, and complication risks of both approaches. Materials and methods: Sixty-six patients who underwent TUR-BT under spinal anesthesia were randomly selected, and ONB was performed on the tumor location side using classic (n = 33) or inguinal (n = 33) approaches. Ten milliliters of 0.25% bupivacaine were administered using a peripheral nerve stimulator in both approaches.Two endpoints were defined in the study: Primary endpoint; the duration of the determination of the obturator nerve and number of interventions when each participant is assessed in at the end of the ONB procedure. Secondary endpoint; development of contractions, and complications each participant is assessed during the TUR-BT and 24 hours after ONB. (Clinical Trial Registration Number: ACTRN12617001050347)Result: General anesthesia was applied to the five patients in the classic ONB group who detected diffuse or bilateral tumors. These patients were excluded from the study. Contractions developed in 4 patients in each group, no statistically significant difference was detected between the groups (14.3%, n = 4 versus 12.1%, n = 4) (P = 1.00). No complications were detected in both groups during the TUR-BT and 24 hours after ONB. We found that the inguinal approach provided a statistically significant advantage regarding the number of punctures (1.9 ± 0.9 versus1.5 ± 0.7) (P = .036), and duration of the procedure (99.1 ± 48.4 seconds versus 76.0 ± 31.9 seconds) (P=.029) compared with the classic approach. Conclusion: Although complications and success rates were similar in both groups, the inguinal method may be abetter approach because it is faster and requires fewer punctures.
A nightmare during endoscopic bladder tumor resection; obturator reflex
Bladder Tumor is the most common cancer type among urologic cancers and causes high mortality-morbidity if it is not treated early and appropriately. Although there are lots of causes and risks of bladder tumor and it is known that tobacco smoking is the main contributor to bladder tumor, etiology of tumor is not clear. At diagnosis, it is generally seen as a superficial tumor. Transurethral resection of bladder cancer (TUR-B) is the primary surgical method for the diagnosis, staging and treatment of primary or recurrent non-muscle-invasive bladder cancer. In this procedure, different complications may occur, especially bleeding, and the most important complication is bladder perforation. Additional therapies are needed depending on location and size of perforation. An intraperitoneal perforation can lead to laparotomy, bladder repair and open drainage of the abdominal cavity. Sudden adductor muscle spasm can occur when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope, especially when the surgeon is operating at the lateral wall of the bladder, where the obturator nerve runs in close proximity during its intrapelvic course. Therefore, the type of anesthesia is important in the lateral wall tumors of the bladder. Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. We aimed to form a review to reduce difficult situations and to minimize the adverse consequences caused by this reflex that becomes a nightmare in many surgical cases.
Urology journal, 2014
The aim of this study was to compare the recurrence rates of patients with bladder tumors on the lateral wall undergoing transurethral resection of bladder tumor(TUR-BT) with or without obturator nerve block (ONB) and to investigate the impact of ONB on the effective tumor resection on the lateral bladder wall. All patients who underwent TUR-BT under spinal anesthesia within the three-year study period in the study center were reviewed retrospectively. Among these, 68 patients who had been diagnosed with de novo lateral bladder wall tumor and included in low risk group 1n accord with European Organization for Research and Treatment of Cancer (EORTC) classification, undergone complete resection were enrolled into the study. Group 1 (36 patients who underwent TUR-BT with only spinal anesthesia) and group 2 (32 patients who underwent TUR-BT with spinal anesthesia plus ONB) were evaluated with respect to tumor recurrence rates and disease-free time to recurrence, if any. Follow-up perio...