The obturator nerve passes in close proximity to the inferolateral bladder wall, bladder neck and lateral prostatic urethra. During a transurethral operation resection in these areas may result in stimulation of the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To block this reaction d-tubocurarine and succinylcholine can be used during general anesthesia. However, it often is preferable to use spinal anesthesia during transurethral operations. Local anesthetic blockade of the obturator nerve as it passes through the obturator canal if effective for adductor spasm during spinal anesthesia. We herein describe the anatomy, pharmacology, technique and results of local obturator nerve blockade.

Of 343 patients who underwent pelvic lymph node dissection during treatment for carcinoma of the prostate 25 had persistently elevated serum enzymatic acid phosphatase levels preoperatively: 15 (60 per cent) had metastases to the pelvic lymph nodes and 10 (40 per cent) had negative nodes. Bone metastases occurred in 10 of 12 (83 per cent) and 5 of 7 patients (71 per cent), respectively, who were followed for a minimum of 2 years. Of the 318 patients with normal serum enzymatic phosphatase levels 70 (22 per cent) had positive nodes. A persistently elevated serum enzymatic acid phosphatase level in patients with proved carcinoma of the prostate, with elimination of infrequent causes of enzyme elevation, indicates metastases and has significant implications regarding staging and, thus, therapy of this disease.