Effectiveness and Safety of a Modified Technique of Transvesical Obturator Nerve Block to Avoid Adductor Contractions during Transurethral Resection of Bladder Tumors

<b><i>Introduction:</i></b> The aim of the study was to evaluate the effectiveness of a modified transvesical obturator nerve block (ONB) in the prevention of obturator nerve reflex and consecutive bladder perforations (BPs) during transurethral resection of bladder tumors (TURBTs). <b><i>Materials and Methods:</i></b> A retrospective analysis of all patients resected in 2014–2015 due to a bladder tumor of the lateral walls, including a follow-up period until December 2018, was performed. Two groups were defined: in the first group, all patients underwent TURBT with a modified transvesical ONB. The second group underwent conventional TURBT with intermittent resection. Primary endpoints were the rates of adductor contractions and BPs. <b><i>Results:</i></b> Ninety-four out of 1,145 resected patients presented with tumors on the lateral wall of the bladder and a complete dataset including a long-term follow-up. Thirty-six patients were treated in the ONB group, and 58 patients comprised the control group. The median age in the 2 groups was 70.8 and 71.8 years in the first and second groups, respectively. Adductor spasms were reported in 8.33 versus 25.86% (<i>p</i> = 0.057) and perforation in 2.78 versus 17.24% (<i>p</i> = 0.047) in groups 1 and 2, respectively. After a median follow-up of 32.5 months, there was no significant difference in recurrence rates (52.78 vs. 51.72%, <i>p</i> = 0.672). In a subgroup analysis, lower perforation rates were recorded for the ONB group in patients with tumors &#x3c;3 cm (0/30 vs. 8/46, <i>p</i> = 0.076) and in patients with unifocal tumors (0/12 vs. 5/23, <i>p</i> = 0.141). <b><i>Discussion/Conclusion:</i></b> The simplified approach of transvesical ONB demonstrated in this study appears to be an inexpensive, safe, effective, and simple-to-use technique.

A Case Report of Femoral Hematoma following Obturator Nerve Block

Background. When an obturator nerve block (ONB) is performed, the conventional landmark method or ultrasound-guided method is used. The major complications of this block are hematoma, but there are very few reports of its complications. We encountered massive bleeding and a huge hematoma after ONB. Case Presentation. A 95-year-old female underwent transurethral resection of the bladder tumor. Induction of anesthesia was accomplished via spinal anesthesia and right ONB using the landmark method. Postoperatively, subcutaneous bleeding was detected in the lower right interior thigh. Concentrated red cell transfusion was conducted to address the anemia. There was no subsequent expansion of the hematoma. It resolved on postoperative day (POD) 53. The hematoma was deemed to be inadvertently introduced due to an obturator artery puncture during the obturator nerve block. Conclusions. Close attention is necessary to avoid advancing the needle too deep into the obturator during obturator nerve block.

Fuzzy C-Means Algorithm-Based Adoption of Obturator Nerve Block under Adaptive Ultrasound Imaging for Bladder Tumor

This work aimed to study the adoption of obturator nerve block (ONB) based on adaptive medical ultrasound imaging under C-means algorithm in transurethral resection of bladder tumor (TURBT). 120 patients with bladder tumors were diagnosed by C-means algorithm-based ultrasound imaging and were enrolled into group A (epidural anesthesia + resection), group B (general anesthesia), and group C (epidural anesthesia + ONB), each with 40 cases. The accuracy of the detection method, noise level, and complications before and after the operation were compared. All patients received TURBT for treatment. There was no significant difference in the general information of patients in each group ( P > 0.05 ). As a result, the correct segmentation rate of the tumor region segmented by ultrasound imaging by C-means algorithm reached 95.6%. The incidence of obturator nerve reflex (ONR) in group A (7.5%) was greatly inferior to groups B and C ( P < 0.05 ). The length of hospital stay in group A was (4.01 ± 1.43) days, which was notably different from groups B and C, with considerable difference among the three ( P < 0.05 ). In short, the adaptive medical ultrasound imaging under C-means algorithm was more accurate in the diagnosis of bladder tumors. Moreover, ONB can effectively reduce the ONR and the incidence of complications in patients.

Transurethral resection of bladder tumor surgery conducted using epidural anesthesia and obturator nerve block in an elderly multimorbid male

pidural Anesthesia (EA) is mainly used for perioperative and postoperative analgesia, usually combined with Spinal Anesthesia (SA) or General Anesthesia (GA). It is safe, easy to perform, and has multiple applications. The benefits of Regional Anesthesia (RA) over general anesthesia include superior analgesia, reduced opioid consumption, reduced pulmonary complications, improved gastrointestinal function, early mobilization, a reduced need for thrombo-prophylaxis, early discharge, and higher patient satisfaction. Anesthesia for urological surgeries has unique problems due to patient factors and procedure complexity. An 84-year older man with a known history of hypertension/ Coronary Artery Disease (CAD)/ complete Left Bundle Branch Block (LBBB)/ dilated cardiomyopathy/ glottic carcinoma/ mixed airway disease, with an ejection fraction of 30%, was scheduled to undergo Transurethral Resection of Bladder Tissue (TURBT) for carcinoma bladder mass. It was done under EA and an ipsilateral obturator nerve block.

A COMPARATIVE STUDY BETWEEN CLASSIC AND INTERADDUCTOR APPROACH OF OBTURATOR NERVE BLOCK WITH ROPIVACAINE IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF BLADDER TUMOUR UNDER SPINAL ANAESTHESIA.

Background: The most signicant use of ONB i.e., obturator nerve block is to prevent adductor muscle contraction associated with Transurethral resection of bladder tumours (TURBT). Adductor jerk during TURBT may cause serious injury to urinary bladder like laceration with involvement of blood vessels, severe bleeding, bladder wall tear and perforation and even partial resection of bladder tumour due to frequent distraction and interruption to the surgeon.1 So, there is need for evaluation and comparison of different techniques of ONB in view of safety and efcacy. We have conducted a randomized clinical study to compare the classic pubic and inter adductor approach for ONB with spinal anaesthesia for transurethral resection of bladder wall tumour masses. Method: A total number of 50 patients of either sex of ASA physical status I or II, of age group 30-75 years, who were posted for TURBT operation under spinal anaesthesia, were included in this study. A Prospective single blind randomised controlled trial and cross over study was conducted. Peripheral nerve stimulator to localize the nerve and Inj. Ropivacaine 0.5% ,15 ml on each side was used in this study. Result: The overall success rate in classic pubic approach was slightly lower than interadductor approach which was statistically insignicant. There were more instances of vessel puncture in pubic approach, which was statistically signicant (p value = 0.016). There was no incidence of other signicant complications. Conclusion: In terms of ease of obturator nerve block and incidence of complications the interadductor approach is better than classic pubic approach.

Anatomical considerations for obturator nerve block with fascia iliaca compartment block

This report reviews the topographical and functional anatomy relevant for assessing whether or not the obturator nerve (ON) can be anesthetized using a fascia iliaca compartment (FIC) block. The ON does not cross the FIC. This means that the ON would only be blocked by an FIC block if the injectate spreads to the ON outside of the FIC. Such a phenomena would require the creation of one or more artificial passageways to the ON in the retro-psoas compartment or the retroperitoneal compartment by disrupting the normal anatomical integrity of the FI. Due to this requirement for an artificial pathway, an FIC block probably does not block the ON.

Obturator nerve block

One of the forgotten techniques of regional anesthesia is blockade of the obturator nerve, which was performed using anatomical landmarks and neurostimulation. In recent years, ultrasonic navigation methods have gained wide popularity when using regional blockades. The purpose of the review is to present the current understanding of the use of obturator nerve block in clinical practice. The review presents the anatomical features of the obturator nerve passage, surgical and therapeutic indications for the use of its blockade. The technique for performing obturator blockade using ultrasound navigation is described in detail. Blockade of the obturator nerve using ultrasound navigation can reduce the likelihood of surgical complications during transurethral resection of a tumor located on the lateral wall of the bladder, improve analgesia after hip and knee surgery, and effectively relieve spastic conditions of the adductor muscles of the hip.