Comparison of different methods of obturator nerve block in transurethral resection of bladder tumors: A systematic review and network meta‐analysis

Abstract

Background: Bladder cancer is the most common malignancy of the urinary system, and accounts for 3% of newly diagnosed tumors. Transurethral resection of bladder tumor plays a key role in treating bladder cancer, among which one of the most serious complications is bladder perforation caused by obturator nerve reflex. Obturator nerve reflex can be prevented by inducing obturator nerve block after lumbar anesthesia. However, No study so far has compared the inhibitory effect of different obturator nerve block approaches on intraoperative obturator nerve reflex and bladder perforation. Method:In this study, we conducted a network meta-analysis (NMA) of studies comparing the efficacy of different obturator nerve block approaches performed after lumbar anesthesia in operation. Result:The distal obturator nerve block guided by peripheral nerve stimulator is the best approach for preventing obturator reflex. The proximal obturator nerve block guided by ultrasound is the best approach for preventing bladder perforation. Conclusion:Spinal anesthesia combined with the distal obturator nerve block guided by peripheral nerve stimulator is the most optimal approach to prevent the obturator nerve reflex. But the doctor should choose the appropriate anesthesia method according to the patient's general condition, tumor location, and doctor's proficiency in puncture techniques. K E Y W O R D S bladder cancer, lumbar anesthesia, obturator nerve block, transurethral resection of bladder tumor | 5421 WU et al.

Comparison of the obturator nerve block performed blinded according to the anatomical signs and ultrasound-guided obturator nerve block in patients undergoing transurethral resection: randomized controlled trial

“…Perioperative bleeding was observed in only one patient in the ultrasound-guided ONB group and 3 patients in blind group. Our ndings are consistent with a recent meta-analysis by Wu et al [14]. The authors reported that ultrasoundguided technique was the optimum approach in terms of preventing bladder perforation.…”

“…In a very recent meta-analysis, various ONB approaches were compared in terms of preventing ON re ex and related complications. ONB performed with nerve stimulator was found to be superior to ultrasound-guidance or blind technique in preventing muscle contractions [14]. Despite this result, ultrasound-guidance has become very popular in regional anesthesia practice in the last decade by providing practical, time-saving procedures for clinicians when compared to using a nerve-stimulator.…”