Ultrasound Guided Obturator Nerve Block (Two Branches) With Spinal Anesthesia In Transurethral Resection Of Bladder Tumor

Abstract

Background: patients with bladder tumor mostly treated surgically with transurethral resection (TURBT). For anesthetic aspect, general anesthesia and/or neuroaxial block could be done, but spinal anesthesia is the most common procedure takes a place in the theatre. During cauterization (electro-resection) of the tumor the obturator nerve (L2, L3 & L4) will be stimulated resulting in thigh adductor jerk (as it passes through the infero-lateral wall of the bladder). In some patients, the adductor jerk (reflex) may cause unwanted complications such as bleeding and bladder wall perforation. Obturator nerve block is a successful measure to prevent this incidence intra-operatively.
Methods: 42 eligible (adult age and above) patients, randomly divided into two groups, both received spinal anesthesia with hyperbaric bupivacaine (0.5%) 3 ml. The 1st group (A) has been intervened with obturator nerve block (anterior branch) with 3 ml of plane bupivacaine 0.5%. The 2nd (B) group has been intervened with obturator nerve block (both anterior and posterior branches) with 3 ml of plane bupivacaine 0.5% for each branch. Timing of the procedure and surgery, adductor jerks closed monitored by both the surgeon and the anesthetist, bladder perforation, bleeding also recorded by the surgeon.
Results: The adductor jerk (during cauterization of the tumor) was obviously absent in most of the patients in group B, also the bleeding was reduced to a convenient level by the surgeon.
Conclusion: Based on this study, obturator nerve block (two branches) is necessary for patients’ underwent transurethral resection of the bladder tumor with low volume and prolonged timing local anesthetic agent, especially if the tumor invades the lateral or inferolateral wall of the urinary bladder.