Comparison of inguinal versus classic approach for obturator nerve block in patients undergoing transurethral resection of bladder tumors under spinal anesthesia (original) (raw)
Related papers
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.
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 ...
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.
A New Inguinal Approach for the Obturator Nerve Block
Anesthesiology, 2005
Background: Obturator nerve block is highly recommended for knee surgery in addition to a femoral nerve block. The main disadvantage of the classic approach at the pubic tubercle is low patient acceptance due to pain and discomfort. The authors hypothesized that the use of a new inguinal obturator nerve block technique would reduce pain and discomfort in patients.
journal of medical science and clinical research, 2017
This was a prospective randomized study, conducted to evaluate the efficacy of Obturator Nerve blocks using nerve stimulator in Transurethral Resection of Bladder Tumor (TURBT) under spinal anaesthesia. Aim and Objectives: To study the effectiveness of Obturator nerve block given by nerve stimulation technique to block the adductor jerk under spinal anaesthesia during Transurethral Resection of Bladder Tumor (TURBT). Material and Methods: Total 60 patients, aged between 45 and 70 years belonging to ASA physical status I-III, having inferolateral wall and bladder neck tumors that were scheduled for transurethral resection of bladder tumor at risk for electrical stimulation as determined by the attending surgeon and divided them into Group I and II. Patient in Both Group I and Group II received Inj Bupivacaine (0.5% hyperbaric/ heavy) for subarachnoid block. In Group II patients, after spinal anaesthesia was given Unilateral or bilateral Obturator Nerve block was given depending on the site of tumor by Nerve Stimulation technique using 10 ml of 0.75 % Ropivacaine. During the operative procedure, the primary endpoint of the study was resectability of the tumor whether it hampered or unhampered by adductor reflex under spinal anaesthesia. Complications like bleeding and bladder perforation were the secondary endpoints of this study. Results: Only 5 (16.66%) patients in Group I , which does not received the Obturater nerve block, have no or minimum adductor muscle jerk in intraoperative period but 25 (83.33%) patients had significant adductor muscle jerk and required general anaesthesia with muscle relaxation for continuation of procedure. In Group II in which the Obturator nerve block is given after spinal anaesthesia only one patient(3.33%) required general anaesthesia and 29 (96.66%) patients was operated in spinal anaesthesia with Obturator nerve block. The incidence of bladder perforation which is a serious complication was 6.6% in Group I and there is no incidence of bladder perforation in Group II. Total requirement of blood product are significantly more in Group I (16.66%) as compare to Group II (2.66%). Conclusions: Transurethral resection of the bladder tumor can be perform successfully under spinal anaesthesia, supplemented with Obturater Nerve block using nerve stimulation technique with minimum side effect. Thus, Obturater nerve block has become an essential component of spinal anesthesia for TURBT.
Abstract Background: Obturator nerve (ON) stimulation during transurethral resection of lateral and posterolateral bladder wall tumour under spinal anesthesia may lead to adductor contraction and leg jerking with complications like bleeding, bladder perforation or incomplete tumor resection. Our study was carried out to obtain successful block of ON using ultrasound-guided technique with and without nerve stimulation in patients undergoing transurethral resection of bladder tumour ( TURBT) under spinal anesthesia. Aims: The aim of the study was to compare the effectiveness of two different techniques in blocking obturator nerve during TURBT. Settings and Design: Prospective, randomized, double blind study. Methods and Material: 60 patients with ASA status II and III, scheduled for TURBT with lateral and posterolateral bladder wall tumour were enrolled. Group I (US group, n=30) patients received 5ml of bupivacaine 0.5% each at anterior and posterior division of obturator nerve under real-time ultrasound visualization and Group II (US-NS group, n==30) received same amount of bupivacaine 0.5% for each division using US-guidance with nerve stimulation-assisted technique. Motor block onset time, block success and performance time, ease of performance of block and complications were measured in two groups. Statistical Methods used: SPSS using two sample independent t-test and Pearson’s Chisquare / Fisher’s Exact test. Results: Motor block onset was significantly faster in group II (6.67 ± 2.40) than in group I (12.39 ± 2.55). A success rate of 90% was achieved in group II as compared to 76.7% in group I with increased block performance time in group II (4.47 ± 0.73 min) vs (2.10 ± 0.51 min) in group I.A better patient and surgeon satisfaction was seen in group II. Conclusion: We conclude that both techniques are safe and easy to perform however nerve stimulation as an adjunct to ultrasound results in a faster onset of block with a higher success rate. Keywords: Obturator nerve block, ultrasound, nerve stimulation, Obturator reflex.
O ur patient, a 90 yr. old gentleman, weighing 70 kilogram, with a CT diagnosis of Stage IV Carcinoma bladder was scheduled for a palliative endoscopic fulgaration or transurethral resection of bladder tumor ( TURBT ) . His complaints were dysuria and hematuria for which he already had a Foleys catheter in situ. He was a known hypertensive for past 20 years on Tab Atenolol 25 mg once daily, Tab Indapamide 2.5 mg once daily, Tab Atorvastatin 40 mg once daily (at bed time) and Tab Aspirin 75 mg once daily. His investigations were as follows: Hemoglobin-11 gm%, Packed cell volume -32 %, Platelet count-1.8 lacs/cumm, Blood urea-27 mg%, Serum creatinine-1 mg%, Serum sodium-140 meq/L, Serum potassium-4 meq/L, random blood sugar-118 mg%. His 12 lead electrocardiogram and 2D echocardiogram were within normal limits. The Urologist informed us that it was a stage IV carcinoma bladder which was as a sessile growth on the right lateral wall of urinary bladder. He was worried because while if the obturator nerve gets stimulated during surgery, thebladder can get perforated. Hence we planned spinal anesthesia along with ultrasound guided right obturator nerve block for surgery. We per-
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: ...
Attenuation-of-adductor-spasm-by-ultrasound-guided-obturator-nerve-block-for-TURBT
Science Fair Open Library, 2014
Violent contraction of adductor muscles or adductor muscle spasm, also known as obturator reflex is a dangerous problem that can happen during transurethral resection of bladder tumor ( TURBT ) under regional anesthesia leading to complications like bladder wall perforation, bleeding and on many occasions is responsible for abandoning the surgery. Spinal anesthesia with selective obturator nerve block is described by many that can prevent adductor spasm if the block is successful.Obturator nerve block by landmark technique or by nerve stimulator has a significant failure rate. By performing this block under ultrasound guidance, the success rate of block increases and the incidence of inadvertent complications described during TURBT also comes down. We report successful anesthesia management of a 90 yrs. Old male with stage IV bladder cancer involving right lateral wall of bladder under spinal anesthesia and right sided ultrasound guided obturator nerve block