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.

scholarly journals Transurethral resection of bladder tumor surgery conducted using epidural anesthesia and obturator nerve block in an elderly multimorbid male

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Ankita Kabi ◽  
◽  
Rekha Kumari ◽  
Shivanand Bone ◽  
◽  
...  
Keyword(s):  
General Anesthesia ◽  
Nerve Block ◽  
Transurethral Resection ◽  
Early Mobilization ◽  
Early Discharge ◽  
Pulmonary Complications ◽  
Obturator Nerve ◽  
Glottic Carcinoma ◽  
Bladder Tissue ◽  
Obturator Nerve Block

pidural Anesthesia (EA) is mainly used for perioperative and postoperative analgesia, usually combined with Spinal Anesthesia (SA) or General Anesthesia (GA). It is safe, easy to perform, and has multiple applications. The benefits of Regional Anesthesia (RA) over general anesthesia include superior analgesia, reduced opioid consumption, reduced pulmonary complications, improved gastrointestinal function, early mobilization, a reduced need for thrombo-prophylaxis, early discharge, and higher patient satisfaction. Anesthesia for urological surgeries has unique problems due to patient factors and procedure complexity. An 84-year older man with a known history of hypertension/ Coronary Artery Disease (CAD)/ complete Left Bundle Branch Block (LBBB)/ dilated cardiomyopathy/ glottic carcinoma/ mixed airway disease, with an ejection fraction of 30%, was scheduled to undergo Transurethral Resection of Bladder Tissue (TURBT) for carcinoma bladder mass. It was done under EA and an ipsilateral obturator nerve block.

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

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