A Comparison Between Blind and Nerve Stimulation Guided Obturator Nerve Block in Transurethral Resection of Bladder Tumor

Khorrami, Mohammad-Hatef; Hadi, Mazaher; Javid, Amir; Izadpahani, Mohammad-Hossein; Sichani, Mehrdad Mohammadi; Zargham, Mahtab; Alizadeh, Farshid

doi:10.1089/end.2012.0037

Cited by 22 publications

(20 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1116] However, no complications were seen during our study as also reported by many other studies comparing blind, US-guided, and US nerve stimulator-guided ONB for transurethral surgery. [171626]…”

Section: Discussionmentioning

confidence: 99%

Obturator nerve block in transurethral resection of bladder tumor: A comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique

2017

View full text Add to dashboard Cite

Background:Obturator nerve (ON) stimulation during transurethral resection of lateral and posterolateral bladder wall tumor under spinal anesthesia may lead to obturator reflex, adductor contraction, and leg jerking with complications such as bleeding, bladder perforation, or incomplete tumor resection. Our study was carried out to obtain successful block of ON using ultrasound (US)-guided technique with or without nerve stimulation in patients undergoing transurethral resection of bladder tumor (TURBT) under spinal anesthesia.Aims:The aim of the study was to compare the effectiveness of two different techniques in blocking ON and adductor spasm during TURBT.Settings and Design:Prospective, randomized, double-blind study.Subjects and Methods:Sixty patients with American Society of Anesthesiologists Status II and III scheduled to undergo TURBT for lateral and posterolateral bladder wall tumor were enrolled. Group I (US group, n = 30) patients received 5 ml of bupivacaine 0.5% each at anterior, and posterior division of ON under real-time US visualization and Group II (US-NS group, n = 30) received the 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 besides assessing patient and surgeon satisfaction into two groups.Statistical Methods Used:SPSS using two sample independent t-test and Pearson's Chi-square/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) versus (2.10 ± 0.51 min) in Group I. A better patient and surgeon satisfaction were seen in Group II with combination of US and nerve stimulation technique. No complications were encountered.Conclusion:We conclude that both techniques are safe and easy to perform; however, nerve stimulation as an adjunct to US results in a faster onset of block with a higher success rate.

show abstract

Section: Discussionmentioning

confidence: 99%

Obturator nerve block in transurethral resection of bladder tumor: A comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique

2017

View full text Add to dashboard Cite

show abstract

“…This nerve block may be performed by the guide of nerve stimulation or anatomic landmarks. [22][23][24] Moreover, more recent studies reported that the use of an ultrasound in regional anesthesia is associated with higher success rates as 93% to 97.2% in ultrasound-guided ONB procedures. 21,25 Akkaya and colleagues demonstrated a new methodological approach based on a sono-anatomic study to visualize the obturator nerve.…”

Section: Discussionmentioning

confidence: 99%

Impact of nerve stimulator-guided obturator nerve block on the short-term outcomes and complications of transurethral resection of bladder tumour: A prospective randomized controlled study

Bolat

Aydoğdu²,

Tekgül³

et al. 2015

CUAJ

View full text Add to dashboard Cite

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: The differences between groups regarding mean operation time, tumour size, and number were not statistically significant (p > 0.05). Adductor muscle contraction was detected in 40% of patients in Group SA and 11.4% in Group ONB. This difference was statistically significant (p = 0.021). Complete bladder perforation was detected in 2 patients in Group SA, whereas no perforation was observed in Group ONB. There was no case of severe bleeding in both groups. Conclusions: We found that ONB performed after spinal anesthesia was effective in preventing intraoperative complications due to adductor muscle spasm while performing TURBT. Our study limitations include its small sample size, since we only enrolled patients with primary lateral wall-localized bladder tumour. Also, we excluded patients who underwent bipolar TURBT.

show abstract

“…2,3 The pudendal nerve is called the social nerve because of its effect on bowel, sexual and bladder functions. Shafik et al demonstrated clinical and neurophysiological improvement in patients with interstitial cystitis following decompression of the pudendal nerves.…”

Section: Departments Of Pathology Urology and Oncologymentioning

confidence: 99%

“…Shafik et al demonstrated clinical and neurophysiological improvement in patients with interstitial cystitis following decompression of the pudendal nerves. 3 Voiding complaints occur in 58.5% of patients with pudendal neuropathy. Urge incontinence, frequency and painful bladder are improved or cured in more than 60% of the cases with pudendal nerve decompression by either a transgluteal or transperineal approach.…”

Section: Departments Of Pathology Urology and Oncologymentioning

confidence: 99%

Re: Editorial Comment on Urologists' Self-Referral for Pathology of Biopsy Specimens Linked to Increased Use and Lower Prostate Cancer Detection (Health Aff [Millwood] 2012; 31: 741–749)

Epstein

2013

Journal of Urology

View full text Add to dashboard Cite

between experiencing a perforation and age could be demonstrated (OR 1.01, 95% CI 0.98 -1.03, p ϭ 0.512).Type of anesthesia has not been evaluated. However, at our center we perform TURBTs mostly using regional anesthesia. Various anesthetic and surgical methods have been attempted to inhibit reflectory adductor muscle reaction during TURBT, including local blockade of the obturator nerve, periprostatic and subvesical anesthetic infiltration, reduction of the electrocoagulation voltage and general anesthesia with muscle relaxants. 1-3 In case of laterally placed tumors we perform reduction of the electrocoagulation voltage and, if necessary, even obturator nerve blockade. General anesthesia is used during the second TURBT if problems were evident during the primary resection. LETTERS TO THE EDITOR/ERRATA

show abstract

A Comparison Between Blind and Nerve Stimulation Guided Obturator Nerve Block in Transurethral Resection of Bladder Tumor

Abstract: Transvesical ONB is a safe and effective method of ONB before TURBT. This method is feasible by urologists and promising even without nerve stimulation and only by anatomic landmarks.

Cited by 22 publications

References 11 publications

Obturator nerve block in transurethral resection of bladder tumor: A comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique

Obturator nerve block in transurethral resection of bladder tumor: A comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique

Impact of nerve stimulator-guided obturator nerve block on the short-term outcomes and complications of transurethral resection of bladder tumour: A prospective randomized controlled study

Re: Editorial Comment on Urologists' Self-Referral for Pathology of Biopsy Specimens Linked to Increased Use and Lower Prostate Cancer Detection (Health Aff [Millwood] 2012; 31: 741–749)

Contact Info

Product

Resources

About