Obturator Nerve Block Using Levobupivacaine for the Prevention of Adductor Spasm in Transurethral Bladder Tumor Resection

Darçın, Kamil; Bengisun, Züleyha Kazak; Ekmekçi, Perihan Elif; Haliloğlu, Ahmet Hakan; Süer, A. H.

doi:10.5336/medsci.2012-28161

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…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%

“…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%

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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

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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.

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“…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%

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

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

Rychkov¹

2020

Regional Anesthesia and Acute Pain Management

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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.

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Is Obturator Nerve Block Effective as Spinal Anesthesia in Preventing Adductor Spasms in General Anesthesia Without Muscle Relaxants?

Guney¹,

Argun²

2022

Cureus

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Aim: During transurethral resection of bladder tumor (TUR-BT), adductor muscle spasms in varying degrees can be seen due to stimulation of obturator nerve if the tumor is in the inferolateral localization. This can cause some serious complications such as bladder perforation. We aim to show the effectiveness of obturator nerve block (ONB) to avoid the adductor muscle spasm in general anesthesia applied with laryngeal mask (LMA) without using muscle relaxant according to the spinal anesthesia method.Methods: The study has been designed prospectively and observationally. A total of 64 patients who underwent TUR-BT were divided into two groups. Group I consisted of 30 patients in whom TUR-BT was performed under general anesthesia without muscle relaxant + ONB. Group II consisted of 31 patients in whom TUR-BT was performed under spinal anesthesia + ONB. Intraoperative adductor spasm, the severity of adductor response, and surgeon satisfaction were recorded.Results: Median values of adductor muscle strengths were found to be higher in Group I (p < 0.05). There was no statistically significant relationship between the anesthetic method and adductor spasm (p = 0.110). Of patients in Group I, 13.4% showed moderate or severe adductor response, whereas the ratio was 0% in Group II (p = 0.015). Surgeon satisfaction was similar in both groups (p = 0.363).Conclusions: Obturator spasm was not different in both anesthesia techniques. General anesthesia without muscle relaxant combined with ONB was found effective to prevent adductor muscle spasms as the spinal anesthesia in TUR-BT operations. It has been concluded that surgical complications can be reduced via general anesthesia without the muscle relaxant method, although surgeons' satisfaction did not alter. General anesthesia and obturator block applications with the help of LMA without muscle relaxants can be preferred in short-term TUR-B operations where spinal anesthesia is not desired.

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Obturator Nerve Block Using Levobupivacaine for the Prevention of Adductor Spasm in Transurethral Bladder Tumor Resection

Cited by 3 publications

References 9 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

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

Is Obturator Nerve Block Effective as Spinal Anesthesia in Preventing Adductor Spasms in General Anesthesia Without Muscle Relaxants?

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