Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor

Alavi, Cyrus Emir; Asgari, Seyyed Alaeddin; Falahatkar, Siavash; Rimaz, Siamak; Naghipour, Mohammadreza; Khoshrang, Hossein; Jafari, Mehdi; Herfeh, Nadia Rastjou

doi:10.5152/tud.2017.96992

Cited by 6 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on the inclusion and exclusion criteria, 24 studies were included in the NMA. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 The literature screening process is outlined in Figure 1 . There were 19 RCTs and 5 retrospective cohort studies, including 1 three‐arm study.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of different methods of obturator nerve block in transurethral resection of bladder tumors: A systematic review and network meta‐analysis

Gao

Zhang

et al. 2022

Cancer Medicine

View full text Add to dashboard Cite

Background: Bladder cancer is the most common malignancy of the urinary system, and accounts for 3% of newly diagnosed tumors. Transurethral resection of bladder tumor plays a key role in treating bladder cancer, among which one of the most serious complications is bladder perforation caused by obturator nerve reflex. Obturator nerve reflex can be prevented by inducing obturator nerve block after lumbar anesthesia. However, No study so far has compared the inhibitory effect of different obturator nerve block approaches on intraoperative obturator nerve reflex and bladder perforation. Method:In this study, we conducted a network meta-analysis (NMA) of studies comparing the efficacy of different obturator nerve block approaches performed after lumbar anesthesia in operation. Result:The distal obturator nerve block guided by peripheral nerve stimulator is the best approach for preventing obturator reflex. The proximal obturator nerve block guided by ultrasound is the best approach for preventing bladder perforation. Conclusion:Spinal anesthesia combined with the distal obturator nerve block guided by peripheral nerve stimulator is the most optimal approach to prevent the obturator nerve reflex. But the doctor should choose the appropriate anesthesia method according to the patient's general condition, tumor location, and doctor's proficiency in puncture techniques. K E Y W O R D S bladder cancer, lumbar anesthesia, obturator nerve block, transurethral resection of bladder tumor | 5421 WU et al.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Based on the inclusion and exclusion criteria, 24 studies were included in the NMA 8–31 . The literature screening process is outlined in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Comparison of different methods of obturator nerve block in transurethral resection of bladder tumors: A systematic review and network meta‐analysis

Gao

Zhang

et al. 2022

Cancer Medicine

View full text Add to dashboard Cite

show abstract

“…Subsequently, it reduces the possible adverse effects of opioids, such as respiratory depression, nausea, sedation, etc. [7][8][9]. Fentanyl is a powerful synthetic opioid with a potency of 50 to 100 times greater than morphine.…”

Section: Introductionmentioning

confidence: 99%

Comparing spinal anesthesia approaches for transurethral lithotripsy in patients with proximal ureteral stones: A randomized clinical trial of bupivacaine alone versus bupivacaine with fentanyl

Tavakoli,

Khoshrang,

Damavand

et al. 2023

JMedLife

View full text Add to dashboard Cite

Despite the benefits of spinal anesthesia and the preference of anesthesiologists for this technique, it is less accepted by urologists due to the proximity of the stone place in the ureter and the possibility of pain, restlessness, and occasional movements of the patient during surgery. The current study investigated the success of bupivacaine plus intrathecal fentanyl in patients undergoing transurethral lithotripsy (TUL). In this randomized clinical trial, from April 2021 to September 2021, 54 patients with proximal urolithiasis candidates for TUL were enrolled. Patients were randomly categorized into two groups: group A received bupivacaine 10 mg and 0.5 ml of normal saline, while group B received bupivacaine 10 mg with 0.5 ml (25μg) of intrathecal fentanyl. According to our findings, about 74% of the patients were men, and the mean age of the patients was 66.14±22.46 years. The onset time of the sensory block, sensory block level, pain score, degree of relaxation, depth of the motor block, occurrence of anesthesia complications, oxygen saturation, and mean arterial blood pressure were not significantly different between the two groups. However, the duration of the motor block in group B was longer than in group A (p<0.001). Also, retropulsion was observed only in five patients (18.5%) in group A, significantly higher than in group B (p=0.019). Bupivacaine with fentanyl 25μg provided adequate spinal anesthesia with lower retropulsion in patients with urolithiasis who are candidates for TUL.

show abstract

“…At this point, it courses close to the wall of the bladder (3). TUR-BT of bladder tumours localized close to the lateral side of the bladder may stimulate the obturator nerve and trigger the adductor contraction approximately the rate of 20%, causing possible inadvertent bladder perforation or an incomplete resection due to hindrance of the tumour resection (4). Spinal anaesthesia combined with obturator nerve blockade in the obturator canal may be effective in preventing adductor spasm (5).…”

Section: Introductionmentioning

confidence: 99%

“…Various strategies are recommended to prevent undesirable adductor contractions due to obturator nerve stimulation. For instance, the incidence of obturator nerve stimulation can be reduced by attention to technical strategies, decreasing the intensity of energy, avoiding overdistention of the bladder, and using anaesthetic paralysis or giving general anaesthesia during the resection of lateral wall localized tumours to decrease an obturator reflex response (4,6,7). Meta-analyses comparing bipolar and monopolar TUR-BT have reported no statistically significant differences between bipolar and monopolar TUR-BT in terms of obturator reflex and bladder perforation rates (8,9).…”

Section: Introductionmentioning

confidence: 99%

The effect of obturator nerve blockade on oncological outcomes of patients with lateral wall localized non-muscle invasive bladder cancer

Horsanalı¹,

Eren²,

E³

et al. 2021

Preprint

View full text Add to dashboard Cite

Objective: To investigate the effect of obturator nerve blockade on oncological outcomes of patients with a diagnosis of lateral wall localized non-muscle invasive bladder cancer. Materials and Methods: One hundred six patients diagnosed with lateral wall localized non-invasive bladder cancer were evaluated between January 2015 and March 2020 in this retrospective, cross-sectional observational study. The patients were divided into two groups: patients receiving only spinal anaesthesia and those receiving spinal anaesthesia combined with ultrasound-guided obturator nerve blockade. Oncological outcomes of the groups were compared statistically. Results: We observed recurrent tumours in 25 patients (45.5%) in Group 1 and 11 patients (21.6%) in Group 2. In addition, we observed tumour progression in eight patients (14.5%) in Group 1 and two patients (3.9%) in Group 2. We observed statistical significance in differences between groups regarding tumour size, recurrence rate, adequate muscle tissue sampling, the ability for complete resection and persistent obturator reflex. The efficacy rate of obturator blockade was 92.1% in Group 2. One-year recurrence-free survival (RFS) was 98.0% and five-year RFS was 23.5% for Group 1, while they were, respectively, 97.4% and 57.2% for Group 2. Conclusion: The obturator reflex is a common and challenging reflex that may cause major complications and result in unintended consequences such as incomplete resection or tumour recurrence with transurethral resection of bladder tumours. In this study, we demonstrated that combining spinal anaesthesia with obturator nerve blockade for lateral wall localized non-muscle invasive bladder cancer may prevent tumour recurrence and reduce perioperative complications.

show abstract

Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor

Cited by 6 publications

References 20 publications

Comparison of different methods of obturator nerve block in transurethral resection of bladder tumors: A systematic review and network meta‐analysis

Comparison of different methods of obturator nerve block in transurethral resection of bladder tumors: A systematic review and network meta‐analysis

Comparing spinal anesthesia approaches for transurethral lithotripsy in patients with proximal ureteral stones: A randomized clinical trial of bupivacaine alone versus bupivacaine with fentanyl

The effect of obturator nerve blockade on oncological outcomes of patients with lateral wall localized non-muscle invasive bladder cancer

Contact Info

Product

Resources

About