Ultrasound-Guided Obturator Nerve Block

Manassero, Alberto; Bossolasco, Matteo; Ugues, Susanna; Palmisano, Sarah; Bonis, Umberto De; Coletta, Giuseppe

doi:10.1097/aap.0b013e31823e77d5

Cited by 40 publications

(29 citation statements)

References 15 publications

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“…This difference was statistically significant ( P < 0.05). Our results are in congruence with Manassero et al .,[16] who observed a longer block performance time in the USENS group than in the US group (3.0 vs. 1.6 min) while performing ONB. An almost similar time of 2 min has been reported by Sinha et al .,[22] in their study, using US-guided ONB without nerve stimulation.…”

Section: Discussionsupporting

confidence: 93%

“…The ON is one such nerve that can be both, difficult to stimulate electrically and image sonographically. [16] Stimulation of the ON by electric current during TURBT causes sudden jerk (obturator reflex) due to contraction of adductor muscles. This may lead to bladder perforation or deep cut causing profuse bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Manassero et al . [16] conducted the first study to compare interfascial injection versus a neurostimulation-assisted ONB, under US-guidance. They found a similar motor block onset time with US group (7.2 ± 3.6 min) and USENS group (6.2 ± 2.1 min).…”

Section: Discussionmentioning

confidence: 99%

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

2017

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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

2017

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“…The study by Manassero and colleagues (11) in Italy showed that ultrasound-guided obturator nerve block may be performed after the division of the nerve and the injection of local anesthetic between the planes of the adductor muscles is equal to nerve stimulation. Helayel et al (12), in Brazil among 22 subjects, demonstrated that ultrasound-guided obturator-nerve identification and block are technically easy and highly successful.…”

Section: Discussionmentioning

confidence: 99%

Complications in Transurethral Resection of the Bladder Tumor: Using Nerve Stimulator with or Without Ultrasonography for Obturator Nerve Block: A Comparative Study

et al. 2017

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Background: The use of ultrasonographic guide is a suggested way to ease the obturator nerve block procedure. Accordingly, in this study, the procedures by selective obturator nerve block with and without use of ultrasonographic guide were compared. Methods: This interventional study was performed as an open-label randomized clinical trial among 50 consecutive subjects under surgery for intramural tumors of urinary bladder in a training hospital in 2016. The subjects were randomly assigned to be operated under spinal anesthesia accompanied with selective obturator nerve block (10 mL of 1.5% lidocaine adding 1:200000 epinephrine) with or without ultrasonographic guide. The outcomes were compared across the groups.

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“…Recent studies have compared sonographic identification of the obturator nerve versus neurostimulation techniques [23,24]. Techniques can be classified depending on whether the approach is distal or proximal.…”

Section: Obturator Nerve Block (Onb)mentioning

confidence: 99%

Avoiding the Obturator Jerk during TURBT

Panagoda¹,

Vasdev²,

Gowrie‐Mohan³

2018

Current Urology

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Introduction: Bladder cancer is the seventh most common cancer in the UK. Transurethral resection of bladder tumor (TURBT) is a relatively common procedure used to treat cancer of the bladder. A serious complication of TURBT is bladder perforation, the risk of which is greatly increased in the presence of an “obturator jerk”. Methods: A literature search was performed on PubMed using the following search criteria “obturator nerve block”, “obturator nerve block in transurethral resection of bladder tumor”, “adductor spasm during transurethral resection of bladder tumor”, “bi-polar diathermy obturator nerve”, and “transvesical obturator nerve block”. Articles describing surgical and anesthetic techniques for reducing adductor spasm during resection of bladder tumors were included. Discussion: TURBT is a relatively common urological operation performed to remove tumors of the bladder. Every measure should be taken to avoid serious complications from both anesthesia and surgery. Surgical measures to reduce the likelihood of an obturator jerk include reducing the diathermy current, avoiding over-distention bladder, and using bipolar diathermy as opposed to monopolar diathermy (although there is conficting evidence for this in the literature). Anesthetists should consider the use of neuromuscular blockade or an obturator nerve block to reduce the incidence of obturator jerk and risk of bladder perforation.

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Ultrasound-Guided Obturator Nerve Block

Abstract: In ultrasound-guided obturator nerve block performed after the division of the nerve, injection of local anesthetic between the planes of the adductor muscles is comparable to nerve stimulation.

Cited by 40 publications

References 15 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

Complications in Transurethral Resection of the Bladder Tumor: Using Nerve Stimulator with or Without Ultrasonography for Obturator Nerve Block: A Comparative Study

Avoiding the Obturator Jerk during TURBT

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