Transurethral resection of bladder cancer on the lateral bladder wall without obturator nerve block: extent of adductor spasms using the monopolar versus bipolar technique—a prospective randomised study

2018 ◽  
Vol 36 (7) ◽  
pp. 1085-1091 ◽  
Author(s):  
T. Gramann ◽  
C. Schwab ◽  
V. Zumstein ◽  
P. Betschart ◽  
M. Meier ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Nerve Block ◽  
Transurethral Resection ◽  
Bladder Wall ◽  
Obturator Nerve ◽  
Randomised Study ◽  
Obturator Nerve Block ◽  
Prospective Randomised Study

scholarly journals Outcome of Obturator Nerve Block by Inguinal and Transvesical Approach in Transurethral Resection of Bladder Tumor

2020 ◽  
Vol 23 (2) ◽  
pp. 118-123
Author(s):  
Md Mahmud Ur Rahman ◽  
Md Shafiqul Alam Chowdhury ◽  
Md Amanur Rasul ◽  
Sudip Das Gupta ◽  
Mohammed Mizanur Rahman
Keyword(s):  
Nerve Block ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Bladder Wall ◽  
Obturator Nerve ◽  
Obturator Nerve Block ◽  
Significant Difference ◽  
Group A ◽  
Transvesical Approach ◽  
Group B

Introduction and aim of the study : Spinal anaesthesia for transurethral resection of bladder tumor (TURBT) does not prevent unintended stimulation of the obturator nerve when electro resection is performed on the lateral and Postero-lateral wall of the bladder. It results in muscle contraction of the adductor muscles of the thigh, which may lead to perforation of bladder wall with the resectoscope loop. The aim of the study was to compare the outcome of obturator nerve block by inguinal and transvesical approach. Materials and Methods: A prospective experimental study was done in the department of Urology Dhaka Medical College Hospital during the period of November 2016 to April 2018. Total 60 Patients were included for the study as per inclusion and exclusion Criteria. Patients were than allocated purposively into two groups by simple random sampling. Group A consisted of 30 patients where obturator nerve block (ONB) was done by transvesical approach and Group B also consisted of 30 patients where ONB was done by inguinal approach. Results: In the present study, the baseline characteristics of the patients in Group-A and Group-B were almost similar having no statistically significant difference. Obturator jerk more frequently occurred in group-B, in 13 (56.37%) patients following TURBT compared to Group-A, where 05(16.67%) patients developed obturator jerk. The intergroup difference was statistically significant (p<0.05). In case of 26 (86.67%) patients tumour was completely resectable in group-A, while in 21 (70.00%) patients of Group- B tumour was completely resectable. This was not a statistically significant difference (P>0.05). There was no incidence of bladder wall perforation in group-A, wherears this complication occurred in 02 (06.67%) cases of Group-B (p>0.05). Mean operative time in Group-A and group-B is 50.46 (±11.64) and 59.10 (±15.83) respectively (p<0.05). Conclusion: We conclude that transvesical approach is better in case of Jerk elimination and Less Procedure related time than inguinal approach during TURBT Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.118-123

scholarly journals The optimal method of anesthesia for transurethral resection of a lateral bladder wall

2020 ◽  
Vol 14 (2) ◽  
pp. 86-92
Author(s):  
Ivan A. Rychkov
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Nerve Block ◽  
Transurethral Resection ◽  
Sinus Bradycardia ◽  
Randomized Study ◽  
Bladder Wall ◽  
Side Wall ◽  
Obturator Nerve ◽  
Obturator Nerve Block

In our prospective randomized study, 130 patients underwent a transurethral resection (TUR) because a neoplasm was located on the side wall of the bladder. In the neurostimulation (NS) group (n = 50), a spinal anesthesia with an obturator nerve block was made under the control of a neurostimulation; in the ultrasound (US) + NS group (n = 50), a spinal anesthesia with an obturator nerve block was made under the double control of ultrasound navigation and neurostimulation; in the general anesthesia (GA) group (n = 30), a general anesthesia with a deep myoplegia was made. Results: The obturator nerve reflex was recorded for three (6%) patients from the NS group (p 0.001); it caused a bladder perforation in one patient. The frequency of a sinus bradycardia in the NS (18%) and US + NS (20%) groups was lower than in the GA (43%) group, p = 0.008. Arterial hypotension was observed only in the OA group for 8 (27%) patients (p 0.001). In the NS and US + NS groups, the patients time in the surgery room was significantly less (p 0.001) than in the OA group averaging 48.36 17.58 min and 50.82 23.6 min, respectively. Conclusion: The combination of a spinal anesthesia with obturator nerve block under the dual control of an ultrasound navigation and a neurostimulation can be considered as a reliable and safe method of an anesthetic maintenance of the TUR on the wall of the bladder. If it is impossible to provide such a control over the implementation of the blockade, it is necessary to resort to a GA with a deep myoplegia.

A COMPARATIVE STUDY BETWEEN CLASSIC AND INTERADDUCTOR APPROACH OF OBTURATOR NERVE BLOCK WITH ROPIVACAINE IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF BLADDER TUMOUR UNDER SPINAL ANAESTHESIA.

2021 ◽  
pp. 216-220
Author(s):  
Manas Biswas ◽  
Samarendra Nath Samui ◽  
Sarbari Swaika
Keyword(s):  
Nerve Block ◽  
Spinal Anaesthesia ◽  
Transurethral Resection ◽  
Bladder Wall ◽  
Bladder Tumour ◽  
Obturator Nerve ◽  
Severe Bleeding ◽  
Peripheral Nerve Stimulator ◽  
Obturator Nerve Block ◽  
Randomized Clinical Study

Background: The most signicant use of ONB i.e., obturator nerve block is to prevent adductor muscle contraction associated with Transurethral resection of bladder tumours (TURBT). Adductor jerk during TURBT may cause serious injury to urinary bladder like laceration with involvement of blood vessels, severe bleeding, bladder wall tear and perforation and even partial resection of bladder tumour due to frequent distraction and interruption to the surgeon.1 So, there is need for evaluation and comparison of different techniques of ONB in view of safety and efcacy. We have conducted a randomized clinical study to compare the classic pubic and inter adductor approach for ONB with spinal anaesthesia for transurethral resection of bladder wall tumour masses. Method: A total number of 50 patients of either sex of ASA physical status I or II, of age group 30-75 years, who were posted for TURBT operation under spinal anaesthesia, were included in this study. A Prospective single blind randomised controlled trial and cross over study was conducted. Peripheral nerve stimulator to localize the nerve and Inj. Ropivacaine 0.5% ,15 ml on each side was used in this study. Result: The overall success rate in classic pubic approach was slightly lower than interadductor approach which was statistically insignicant. There were more instances of vessel puncture in pubic approach, which was statistically signicant (p value = 0.016). There was no incidence of other signicant complications. Conclusion: In terms of ease of obturator nerve block and incidence of complications the interadductor approach is better than classic pubic approach.

scholarly journals The Effect Of Obturator Nerve Block On Complications During Transurethral Resection Of Lateral Wall Located Bladder Tumours

2011 ◽  
Vol 21 (3) ◽  
pp. 129-133
Author(s):  
Zeki Tuncel Tekgül ◽  
Rauf Taner Divrik ◽  
Murat Turan ◽  
Esen Şimşek ◽  
Ersin Konyalıoğlu ◽  
...  
Keyword(s):  
Nerve Block ◽  
Transurethral Resection ◽  
Lateral Wall ◽  
Obturator Nerve ◽  
Obturator Nerve Block ◽  
Bladder Tumours

scholarly journals OBTURATOR NERVE RLOCK

2009 ◽  
Vol 16 (01) ◽  
pp. 48-52
Author(s):  
NASEEM AHMED ◽  
Shahid Mahmood Rana ◽  
SYED MUHAMMAD ZAHEER HAIDER ◽  
Arshad Mahmood ◽  
FAIZAN AHMED ◽  
...  
Keyword(s):  
Nerve Block ◽  
Spinal Anaesthesia ◽  
Bladder Wall ◽  
Obturator Nerve ◽  
Physical Status ◽  
Effective Technique ◽  
Obturator Nerve Block ◽  
Partial Suppression ◽  
A Prospective Study ◽  
Study Setting

Objectives: To evaluate the efficacy of obturator nerve block combined with spinal anaesthesia for prevention of adductormuscle spasm and its associated complications during transurethral resection of bladder tumours located at its lateral and inferolateral wall.Study design: A prospective study. Setting: At AFIU Rawalpindi. Period: From January 2005 to December 2006. Material and methodFifty patients who had tumours at their lateral / inferolateral bladder wall of physical status ASA I - IV received spinal anaesthesia at 3r d or4l h lumbar space followed by obturator nerve block with a view to preventing adductor jerk during resection of tumour. Results: There wascomplete suppression of adductor jerk in 45 (90%) patients and surgery was completed smoothly. Two patients (4%) had mild adductorjerk and additional sedation was required. The block failed to work in 3 (6%) cases and required conversion to general anaesthesia. Thusthe procedure was successful in 94% (complete and partial suppression of jerk. Conclusion: We conclude that spinal anaesthesiacombined with obturator nerve block is an effective technique for preventing adductor jerk during TUR-BT, thus avoiding intra-operative andpost operative complication.

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