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

Pladzyk K, Jureczko L, Lazowski T - Cent European J Urol (2012)

Bottom Line: Neither hematomas nor neurological adverse events were observed.The described method offers a high rate of efficacy and ensures optimal and safe conditions for the resection of a tumor located on the inferolateral wall of the urinary bladder.The risk of complication is low.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.

ABSTRACT

Introduction and aim of the study: Spinal anesthesia for transurethral resection of bladder tumor (TURB) does not prevent unintended stimulation of the obturator nerve when electroresection is performed on the lateral wall of the bladder. It results in muscle contraction of the adductor muscles of the thigh, which may lead to perforation of bladder wall with the resectoscope loop. The aim of the study was to assess the efficacy and safety of obturator nerve block (ONB).

Methods: This prospective study was conducted between 01/01/1999 and 12/31/2010 in the Department of General, Oncologic and Functional Urology, Medical University of Warsaw. In 431 patients undergoing TURB adductor spasms were observed. In these cases nerve stimulation and ONB with 2% lidocaine using thigh interadductor approach in the lithotomy position were performed.

Results: The efficacy of 542 ONB was 94%. In 31 cases general anesthesia was necessary. There were two cases of urinary bladder perforation, but only one resulted from an insufficient nerve block. Both were managed conservatively. Neither hematomas nor neurological adverse events were observed.

Conclusion: The described method offers a high rate of efficacy and ensures optimal and safe conditions for the resection of a tumor located on the inferolateral wall of the urinary bladder. The risk of complication is low.

No MeSH data available.


Related in: MedlinePlus

Obturator nerve block.
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Figure 0001: Obturator nerve block.

Mentions: Methods of preventing the stimulation of the ON include: reduction of the diathermy power, bipolar resection, general anesthesia, or obturator nerve block (ONB) following spinal anesthesia. Preventing muscle contractions by means of regional anesthesia (different approaches to ON [2, 3]) has been proposed since 1928. The modification of the interadductor approach (described by Wassef) discussed herein does not involve the necessity to change the patient's lithotomy position (Fig. 1).


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

Pladzyk K, Jureczko L, Lazowski T - Cent European J Urol (2012)

Obturator nerve block.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921785&req=5

Figure 0001: Obturator nerve block.
Mentions: Methods of preventing the stimulation of the ON include: reduction of the diathermy power, bipolar resection, general anesthesia, or obturator nerve block (ONB) following spinal anesthesia. Preventing muscle contractions by means of regional anesthesia (different approaches to ON [2, 3]) has been proposed since 1928. The modification of the interadductor approach (described by Wassef) discussed herein does not involve the necessity to change the patient's lithotomy position (Fig. 1).

Bottom Line: Neither hematomas nor neurological adverse events were observed.The described method offers a high rate of efficacy and ensures optimal and safe conditions for the resection of a tumor located on the inferolateral wall of the urinary bladder.The risk of complication is low.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.

ABSTRACT

Introduction and aim of the study: Spinal anesthesia for transurethral resection of bladder tumor (TURB) does not prevent unintended stimulation of the obturator nerve when electroresection is performed on the lateral wall of the bladder. It results in muscle contraction of the adductor muscles of the thigh, which may lead to perforation of bladder wall with the resectoscope loop. The aim of the study was to assess the efficacy and safety of obturator nerve block (ONB).

Methods: This prospective study was conducted between 01/01/1999 and 12/31/2010 in the Department of General, Oncologic and Functional Urology, Medical University of Warsaw. In 431 patients undergoing TURB adductor spasms were observed. In these cases nerve stimulation and ONB with 2% lidocaine using thigh interadductor approach in the lithotomy position were performed.

Results: The efficacy of 542 ONB was 94%. In 31 cases general anesthesia was necessary. There were two cases of urinary bladder perforation, but only one resulted from an insufficient nerve block. Both were managed conservatively. Neither hematomas nor neurological adverse events were observed.

Conclusion: The described method offers a high rate of efficacy and ensures optimal and safe conditions for the resection of a tumor located on the inferolateral wall of the urinary bladder. The risk of complication is low.

No MeSH data available.


Related in: MedlinePlus