Over 500 obturator nerve blocks in the lithotomy position during transurethral resection of bladder tumor

Pladzyk, Karolina; Jureczko, Lidia; Łazowski, Tomasz

doi:10.5173/ceju.2012.02.art2

Cited by 30 publications

(19 citation statements)

References 6 publications

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“…The use of different drug concentrations, and different volumes using different methods, was observed in studies that investigated ONB methods [10][11][12]. Similar to these studies, both the urologists and anesthesiologists used local anesthesia drugs in different concentrations and doses in our study.…”

Section: Discussionmentioning

confidence: 56%

“…In many studies in the current literature, researchers found that ONB was performed with high success and with low complication rates by both urologists and anesthesiologists for the prevention of adductor muscle contraction, regardless of the method used [10][11][12]. However, we found no data regarding how frequently ONB was used in urology clinics in current practice.…”

Section: Introductionmentioning

confidence: 70%

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Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

Dağlı¹,

Dadali²

2018

Arch Med Sci Civil Dis

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Introduction: Adductor muscle contraction may develop due to an electrical stimulus during transurethral resection of bladder tumors (TURBT), and thus bladder wall perforation and vessel-nerve injuries may develop. Studies in the literature demonstrated that obturator nerve block (ONB) was performed with high success and low complication rates to prevent adductor muscle contraction by both urologists and anesthesiologists. However, we found no data suggesting how frequently ONB was used in current practice in urology clinics. We aimed to provide data about ONB and other methods used in current practice to prevent adductor spasm developing during TURBT surgery in urology clinics. Material and methods: A 15-item questionnaire investigating the methods and ONB techniques used against adductor spasm during TURBT surgery was posted by email to urologists after being granted ethics board approval. Results: One hundred seventy urologists completed and returned the forms. Urologists frequently used techniques such as lowering the cautery current (77.6%), immediate stepping on, and stepping off the foot switch (45.8%), decreasing the bladder volume (14.1%), and wall injections (4.7%). The ONB was used by 42 (24.7%) urologists and 22 anesthesiologists (12.9%); general anesthesia was preferred more often. No significant difference was detected in the comparison of the ONB methods or the institutions of the urologists (p = 0.51) and anesthesiologists (p = 0.07). Conclusions: Urologists used different practices in accordance with their personal skills in the prevention of adductor muscle contraction in TURBT procedures. The ONB was preferred less and used less than general anesthesia and muscle relaxants by both urologists and anesthesiologists.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 70%

Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

Dağlı¹,

Dadali²

2018

Arch Med Sci Civil Dis

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“…Konvensiyonel tekniklerle obturator sinir blokajında elde edilen başarı oranı %60-77 olarak bildirilirken [13] Pladzyk ve ark.nın [19] interadduktor tekniğin etkinliği-ni araştırmak için yaptığı 542 hastanın dahil olduğu çalışmada sinir stimülatörü ile blok başarı oranı %94 olarak bulunmuştur. Thallaj ve Rabah [20] bu tekniğin başarı oranını ultrason eşliğinde ölçmüş ve %97'ye ulaşabileceğini belirtmişlerdir.…”

Section: Discussionunclassified

Ultrasound-guided obturator block experience from past year at Kocaeli University Hospital

Aksu¹,

Gürkan

Kuş

et al. 2015

Agri

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ÖzetAmaç: Obturator sinir bloğu, transüretral rezeksiyon sırasında obturator refleksin gelişmesini önlemek için tanımlanmıştır. Tanımlanmasından bu zamana kadar birçok farklı yaklaşım geliştirilmiştir. Bu çalışmada, interadduktor yaklaşımının sonuçlarının görülmesi hedeflenmiştir. Gereç ve Yöntem: Etik kurul onayı alındıktan sonra; Ekim 2013-Ekim 2014 tarihleri arasında transüretral rezeksiyon cerrahisi geçirmiş olan hastaların dosyaları geriye dönük olarak tarandı. Bulgular: Transüretral rezeksiyon geçiren 137 hasta olduğu bulundu. Cerrahi anestezi amacıyla spinal anestezi ve obturator sinir bloğu kombinasyonu uygulanan hasta sayısı 69'du (2'si kadın, 67'si erkek). Bütün obturator sinir blokları interadduktor yaklaşımla, ultrason eşliğinde yapıldı. Obturator refleksin görülmesinden dolayı iki hastada bloğun başarısız olduğu saptandı. Bütün hastaların operasyonları herhangi bir komplikasyona rastlanmadan tamamlandı. Sonuç: Obturator sinir bloğu obturator refleksin önlenmesi için etkili bir bloktur. Obturator sinir bloğunun spinal anestezi ile kombine edilmesi transüretral cerrahilerin anestezisinde güvenli bir yöntem olarak görülmektedir. Obturator sinir bloğunda ultrason rehberliği blok başarı oranının artmasına yardım etmekte ve hasta güvenliği açısından ek avantajlar sağlamaktadır. SummaryObjectives: Obturator nerve block is recommended to prevent obturator nerve reflex during transurethral resection. However, alternate techniques have been developed. The aim of the present study was to examine outcomes of interadductor approach. Methods: After obtaining approval from the ethics committee, files of patients who underwent transurethral resection surgery between October 2013 and October 2014 were reviewed. Results: A total of 137 transurethral resection patients were identified, in 69 ( 2 women, 67 men) of whom a combination of spinal anesthesia and obturator nerve block was used. Obturator nerve blocks were ultrasound-guided with interadductor approach. Nerve block was unsuccessful in 2 cases due to obturator nerve reflex. Surgeries were performed without complication. Conclusion: Obturator nerve block is an effective method of preventing obturator nerve reflex. Combination of obturator nerve block and spinal anesthesia seems to be a safe method of anesthesia in transurethral surgery. Ultrasound guidance improves success rates and provides additional advantages for patient safety.

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“…Nerve stimulation allows identification of the nerve. Pladzyk et al [19] demonstrated the efficacy of the inter-adductor approach to the obturator nerve in the lithotomy position. In their study, the efficacy of 542 ONB was 94% and the risk of complications was low.…”

Section: Obturator Nerve Block (Onb)mentioning

confidence: 99%

Avoiding the Obturator Jerk during TURBT

Panagoda¹,

Vasdev²,

Gowrie‐Mohan³

2018

Current Urology

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Introduction: Bladder cancer is the seventh most common cancer in the UK. Transurethral resection of bladder tumor (TURBT) is a relatively common procedure used to treat cancer of the bladder. A serious complication of TURBT is bladder perforation, the risk of which is greatly increased in the presence of an “obturator jerk”. Methods: A literature search was performed on PubMed using the following search criteria “obturator nerve block”, “obturator nerve block in transurethral resection of bladder tumor”, “adductor spasm during transurethral resection of bladder tumor”, “bi-polar diathermy obturator nerve”, and “transvesical obturator nerve block”. Articles describing surgical and anesthetic techniques for reducing adductor spasm during resection of bladder tumors were included. Discussion: TURBT is a relatively common urological operation performed to remove tumors of the bladder. Every measure should be taken to avoid serious complications from both anesthesia and surgery. Surgical measures to reduce the likelihood of an obturator jerk include reducing the diathermy current, avoiding over-distention bladder, and using bipolar diathermy as opposed to monopolar diathermy (although there is conficting evidence for this in the literature). Anesthetists should consider the use of neuromuscular blockade or an obturator nerve block to reduce the incidence of obturator jerk and risk of bladder perforation.

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Over 500 obturator nerve blocks in the lithotomy position during transurethral resection of bladder tumor

Cited by 30 publications

References 6 publications

Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors

Ultrasound-guided obturator block experience from past year at Kocaeli University Hospital

Avoiding the Obturator Jerk during TURBT

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