Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral resection of urinary bladder tumor.

Autor:	Choudhury S; Department of Urology, Medical College and Hospital, Kolkata, West Bengal, India., Ahmed S; Department of Urology, Medical College and Hospital, Kolkata, West Bengal, India., Bose AGD; Department of Anesthesia, Medical College and Hospital, Kolkata, West Bengal, India., Ghosh D; Department of Anesthesia, Medical College and Hospital, Kolkata, West Bengal, India.
Jazyk:	angličtina
Zdroj:	Urologia [Urologia] 2024 Nov; Vol. 91 (4), pp. 695-700. Date of Electronic Publication: 2024 Jul 26.
DOI:	10.1177/03915603241266907
Abstrakt:	Introduction: Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been managed with trans-urethral resection of urinary bladder tumor (TURBT) for both diagnostic and therapeutic purposes. During TURBT of lateral wall tumors, there is risk of obturator nerve reflex (ONR), which can lead to serious complications such as inadvertent bleeding and urinary bladder perforation. To prevent this, obturator nerve block is given after spinal anesthesia. In this study, we have used the transvesical approach to block the obturator nerve. Materials and Methods: In total, 60 patients were included in the study. In 30 of them, TURBT was performed under only SA and transvesical obturator nerve block (ONB). In the other 30 patients, TURBT was performed under SA and peripheral nerve stimulator (PNS) guided obturator nerve block (performed by anesthetists) was given. The patients underwent TURBT using conventional monopolar cautery. The procedure time and peri-operative complications were studied. In all patients, informed consent was taken. Results: In this study, 30 ONBs (all bilateral) were performed transvesically. After confirming the location of the obturator nerve, transvesical ONB was given using local anesthetic. Two patients (6.67%) experienced adductor jerk during the operation. In the 30 patients who underwent peripheral nerve stimulator (PNS) guided ONB, 6 of the patients (20%) experienced adductor jerk during the operation and 1 of those (3.33%) suffered from urinary bladder perforation which was managed conservatively. Conclusion: Transvesical ONB is an easy method to prevent adductor jerk during TURBT of lateral wall tumors. The learning curve is less and it has a high success rate. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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