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

Abstract

Context:Sparing of obturator nerve is a common problem encountered during transurethral resection of bladder tumor (TURBT) under spinal anesthesia.Aims:To evaluate and compare obturator nerve block (ONB) by two different techniques during TURBT.Settings and Design:This is prospective observational study.Subjects and Methods:Forty adult male patients from the American Society of Anesthesiologists Class I–IV planned to undergo TURBT under spinal anesthesia were divided into two groups of twenty each. In one group, ONB was performed with nerve locator. In other group, transvesical nerve block was performed with a cystoscope. The primary endpoints of this study were the occurrence of adductor reflex, ability to resect the tumor, and number of surgical interruptions. A number of transfusions required and bladder perforation were the secondary endpoints.Results:There was statistically significant difference between the groups for resection without adductor jerk, resection with a minimal jerk, and unresectable with high-intensity adductor jerk. Bleeding was observed in both groups and one bladder perforation was encountered.Conclusions:We conclude that ONB, when administered along with spinal anesthesia for TURBT, is extremely safe and effective method of anesthesia to overcome adductor contraction. ONB with nerve locator appears to be more effective method compared to the transvesical nerve block.

A Systematic Review and Meta-Analysis Comparing the Safety and Efficacy of Spinal Anesthesia and Spinal Anesthesia Combined with Obturator Nerve Block in Transurethral Resection of Bladder Tumors

“…Anatomically, the obturator nerve arises from the anterior thigh of the anterior branch of L 2– L 4 and enters the minor pelvis after the medial border of the psoas muscle comes out; it progresses along the lateral wall of the minor pelvis and protrudes from the obturator canal from the minor pelvis to the thigh, dividing the anterior and posterior branches, and enters the thigh adductor muscle group through the anterior and posterior adductor brevis muscles; during the course of the obturator nerve, it abuts the bladder neck, lateral bladder wall, and prostatic urethra [ 18 ]. Therefore, when TURBT is performed in patients with lateral bladder wall tumors, obturator nerve reflexes often occur due to induced current stimulating the adjacent obturator nerve, which causes involuntary spasms or even sudden and intense movement of the thigh adductor muscle, resulting in bladder perforation, massive hemorrhage, abdominal organ injury, and extravesical spread of the tumor [ 19 ].…”

Can different positions facilitate block application in ultrasound-guided obturator nerve block? A prospective comparative study

“…Obturator nerve block (ONB) is widely used to prevent contractions and sudden movements of thigh adductor muscles during transurethral resection operations of bladder tumor and to relieve adductor muscle spasms in patients with spasticity, to treat chronic hip pain and to improve persistent hip adductor spasticity in patients with paraplegia, for postoperative analgesia in femoral operations, to provide optimal analgesia for patients and to treat pain after hip and knee surgery [6][7][8].…”

Avoiding the Obturator Jerk during TURBT

“…Sharma et al [12] compared ONB performed via a nerve stimulator under spinal anesthesia, to a transvesical approach. They found a statistically significant difference between the groups with regards to the occurrence of obturator jerk, and concluded that blocks performed using a nerve locator appeared to be more effective than a transvesical approach.…”

“…Therefore, avoiding overfilling of the bladder reduces the risk of obturator nerve stimulation. Various other strategies have also been described, such as resecting the tumor on thinner slices, laser resection, reversing the polarity of the diathermy current, and changing the site of the inactive electrode [12]. …”