Transvesical Blockade of the Obturator Nerve to Prevent Adductor Contraction in Transurethral Bladder Surgery

Abstract

Local blockade of the obturator nerve during cystoscopy is an effective method to avoid its stimulation in TURBT. It can be performed easily, and we did not experience any serious complication.

RETRACTED ARTICLE: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial

“…But in 20 % of the patients, lidocaine was applied blindly because the nerve could not be detected with a stimulator. In one case, the adductor contraction sustained despite the ONB [16]. In our cases, if bladder tumor was located at the puncture site, we performed ONB blindly at possible obturator line and around the tumoral region in the bladder.…”

Bipolar Versus Monopolar Transurethral Resection of Nonmuscle-Invasive Bladder Cancer: A Meta-Analysis

“…Aggressive, deep resection or obturator nerve reflex that results in violent adduction of the leg during the resection may cause the injury or even perforation of the bladder wall 28 . Although the success rate of the obturator nerve block to prevent adductor muscle contractions during TURB is over 90% 29 , it is still unavailable to avoid the occurrence of obturator nerve reflex completely, especially when the tumor located on lateral bladder wall. The energies of plasmakinetic bipolar resection is confined within smaller depth of the contact surface, and when saline irrigation is used during bTURB procedure, no current can pass through the body 7 , hence the risk of obturator nerve stimulation is significantly reduced.…”

To study the efficacy of Obturator Nerve blocks using nerve stimulator in Transurethral Resection of Bladder Tumor (TURBT) under spinal anaesthesia

“…In view of the older patients having multi systemic disorder and as TURBT is shorter duration of surgery, spinal anaesthesia has advantage over general anaethesia. The only shortcoming with subarachnoid block is sparing of the Obturator nerve which passed close to lateral wall of bladder tumor can get stimulate due to electric current resulting sudden adductor muscle contraction with a potential complication of bladder rupture or injury during transurethral resection of bladder (TURBT 14 and Khorrami et al 15 described the transvesical blockade of Obturator nerve with 10 ml 1% Lignocaine injected through cystoscope along with spinal anesthesia (thirty patients) and compared it with spinal anesthesia only group (thirty patients). In the intervention group, 34 ONB were performed.…”