Comparison of inguinal versus classic approach for obturator nerve block in patients undergoing transurethral resection of bladder tumors under spinal anesthesia

Abstract

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.

Obturator nerve block in transurethral resection of bladder tumor: A comparative study by two techniques

“…[67] Laser systems are luxurious and not easily available at many centers. General anesthesia is not a suitable option as it is associated with pulmonary complication which is so prevalent in this age group.…”

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

“…9 Different strategies, such as partial filling of the bladder during resection, reducing the intensity of the current of the resectoscope, resecting the tumour on thinner slices, using bipolar or laser resectoscopes, and using general anesthesia with muscle relaxants, are adopted to avoid complications during surgery. 10,11 Bipolar and laser systems are expensive and not available at many centres. The use of general anesthesia and muscle relaxants for TURBT are not recommended, because most patients with bladder tumour are heavy smokers (about 50% of cases).…”

“…The direction of the needle is toward the pelvic contents, which increases the chances of complications. 10 For example, poor nerve blockade can rarely lead to intraoperative obturator jerks that can cause bladder perforation. 3 In addition, the obturator artery accompanies the obturator nerve through the foramen.…”

Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor

“…[24] Obturator nerve blockade can be performed by using various methods and techniques such as classic pubic method by Labat and paravascular superficial inguinal approach. [3] We blocked obturator nerve to prevent jerking by classical approach using a nerve stimulator because the proximal nerve would be blocked and blocking was more effective compared to the inguinal nerve blocking and at the same time, it is more easily to perform and less uncomfortable to patients. It should be declared that, the investigator in this study was experienced with classical approach.…”

“…Accidental adductor muscle spasm during these procedures will induce though infrequent but catastrophic complications such as excessive bleeding, bladder wall perforation, vessel laceration, vascular injury, hematomas and incomplete tumor resection. [1][2][3][4] Therefore various strategies have been implemented to preclude these intraoperative complications such as decreasing the intensity of the current of the resectoscope, application of general anesthesia with muscle relaxants, applying laser resectors, and obturator nerve blockade (ONB), etc. [5,6] But applying spinal anesthesia for transurethral operations has been considered desirable.…”