Ultrasound-Guided Obturator Nerve Block: A Sonoanatomic Study of a New Methodologic Approach

Akkaya, Taylan; Öztürk, Emine; Cömert, Ayhan; Ateş, Yalım; Gümüş, Haluk; Öztürk, Halil; Tekdemi̇r, İbrahi̇m; Elhan, Alai̇tti̇n

doi:10.1213/ane.0b013e3181966f03

Cited by 63 publications

(45 citation statements)

References 12 publications

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“…They reported patient satisfaction rates as high as 93%. 26 These rates show that ultrasound-guided ONB is more successful than a nerve stimulator technique.…”

Section: Discussionmentioning

confidence: 97%

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

Bolat

Aydoğdu²,

Tekgül³

et al. 2015

CUAJ

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Introduction: In this prospective randomized controlled study, we investigated the efficacy of obturator nerve block (ONB) on adductor muscle spasm and related short-term outcomes and complications in patients who underwent transurethral resection of lateral wall-located bladder tumours (TURBT). Methods: Between July 2014 and February 2015, 70 patients scheduled to undergo TUR of lateral bladder wall tumours were enrolled in the study. All patients were preoperatively evaluated by cystoscopy and imaging tools and selected according to localized tumours on the lateral bladder wall. Patients were randomly allocated to Group SA (35 patients who underwent only spinal anesthesia) and Group ONB (35 patients who underwent spinal anesthesia combined with ONB by the nerve stimulator). An independent observer, blinded to the approach, evaluated the obturator signs, including adductor muscle contraction, bladder perforation, and completeness of the resection during the TURBT procedure. Results: The differences between groups regarding mean operation time, tumour size, and number were not statistically significant (p > 0.05). Adductor muscle contraction was detected in 40% of patients in Group SA and 11.4% in Group ONB. This difference was statistically significant (p = 0.021). Complete bladder perforation was detected in 2 patients in Group SA, whereas no perforation was observed in Group ONB. There was no case of severe bleeding in both groups. Conclusions: We found that ONB performed after spinal anesthesia was effective in preventing intraoperative complications due to adductor muscle spasm while performing TURBT. Our study limitations include its small sample size, since we only enrolled patients with primary lateral wall-localized bladder tumour. Also, we excluded patients who underwent bipolar TURBT.

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“…They reported patient satisfaction rates as high as 93%. 26 These rates show that ultrasound-guided ONB is more successful than a nerve stimulator technique.…”

Section: Discussionmentioning

confidence: 97%

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

Bolat

Aydoğdu²,

Tekgül³

et al. 2015

CUAJ

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“…The study by Thallaj and colleagues (9) revealed that ultrasound-guided blockage of obturator nerve was successful in preventing an adductor spasm in all except one patient and patient and surgeon's satisfaction were adequate. In a single-group study among 15 subjects under ultrasound-guided blockage of obturator nerves by Akkaya et al (10) in Turkey, it was demonstrated that ninety-three percent of the patients reported satisfaction from the block.…”

Section: Discussionmentioning

confidence: 98%

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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“…[13,14] Bu konvansiyonel yaklaşımların dışında US'nin rejyonal anestezi pratiği-ne girmesiyle birlikte OSB'nin de US eşliğinde yapıldığı teknikler de tanımlanmıştır. [15][16][17] Wassef [13] 1993 yılın-da anatomik noktalara dayanan interadduktor tekniği tanımlamıştır. Biz kliniğimizde bu teknikle Wassef'in anatomik noktalara dayanan interadduktor yaklaşımı-nı US eşliğinde in-plane teknikle uygulamaktayız.…”

Section: Discussionunclassified

Ultrasound-guided obturator block experience from past year at Kocaeli University Hospital

Aksu¹,

Gürkan

Kuş

et al. 2015

Agri

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ÖzetAmaç: Obturator sinir bloğu, transüretral rezeksiyon sırasında obturator refleksin gelişmesini önlemek için tanımlanmıştır. Tanımlanmasından bu zamana kadar birçok farklı yaklaşım geliştirilmiştir. Bu çalışmada, interadduktor yaklaşımının sonuçlarının görülmesi hedeflenmiştir. Gereç ve Yöntem: Etik kurul onayı alındıktan sonra; Ekim 2013-Ekim 2014 tarihleri arasında transüretral rezeksiyon cerrahisi geçirmiş olan hastaların dosyaları geriye dönük olarak tarandı. Bulgular: Transüretral rezeksiyon geçiren 137 hasta olduğu bulundu. Cerrahi anestezi amacıyla spinal anestezi ve obturator sinir bloğu kombinasyonu uygulanan hasta sayısı 69'du (2'si kadın, 67'si erkek). Bütün obturator sinir blokları interadduktor yaklaşımla, ultrason eşliğinde yapıldı. Obturator refleksin görülmesinden dolayı iki hastada bloğun başarısız olduğu saptandı. Bütün hastaların operasyonları herhangi bir komplikasyona rastlanmadan tamamlandı. Sonuç: Obturator sinir bloğu obturator refleksin önlenmesi için etkili bir bloktur. Obturator sinir bloğunun spinal anestezi ile kombine edilmesi transüretral cerrahilerin anestezisinde güvenli bir yöntem olarak görülmektedir. Obturator sinir bloğunda ultrason rehberliği blok başarı oranının artmasına yardım etmekte ve hasta güvenliği açısından ek avantajlar sağlamaktadır. SummaryObjectives: Obturator nerve block is recommended to prevent obturator nerve reflex during transurethral resection. However, alternate techniques have been developed. The aim of the present study was to examine outcomes of interadductor approach. Methods: After obtaining approval from the ethics committee, files of patients who underwent transurethral resection surgery between October 2013 and October 2014 were reviewed. Results: A total of 137 transurethral resection patients were identified, in 69 ( 2 women, 67 men) of whom a combination of spinal anesthesia and obturator nerve block was used. Obturator nerve blocks were ultrasound-guided with interadductor approach. Nerve block was unsuccessful in 2 cases due to obturator nerve reflex. Surgeries were performed without complication. Conclusion: Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. Ultrasound guidance improves success rates and provides additional advantages for patient safety.

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Ultrasound-Guided Obturator Nerve Block: A Sonoanatomic Study of a New Methodologic Approach

Abstract: Landmarks defined in this clinical trial can be used in patients for obturator nerve block with ultrasound guidance.

Cited by 63 publications

References 12 publications

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

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

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

Ultrasound-guided obturator block experience from past year at Kocaeli University Hospital

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