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Obturator nerve block under double control with ultrasound and neurostimulation during transurethral resection of lateral bladder wall tumors

https://doi.org/10.21292/2078-5658-2019-16-5-12-17

Abstract

50 patients were enrolled in the prospective randomized trials; they all underwent transurethral resection of lateral bladder wall tumors. In general anesthesia group (GA) (n = 25), muscle relaxants were used for general anesthesia; in the group of ultrasound + neurostimulation (US + NS) (n = 25), spinal anesthesia was performed through obturator nerve block with a 2% lidocaine solution of 10 ml under double control: ultrasound navigation and neurostimulation.

Results. An adductor spasm was observed in 5 (20%) patients of the GA group; in the US+ NS group, it was absent (p = 0.025). The frequency of arterial hypotension in the US + NS group was lower compared to the GA group 0 vs 32% (p = 0.004), as well as the frequency of sinus bradycardia: 16% versus 48% (p = 0.032). The patient’s stay in the operating room in the US + NS group was 42 (38; 50) minutes versus 60 (50; 85) minutes in the GA group (p = 0.002). Spinal anesthesia with the obturator nerve block under double control guaranteed the absence of adductor spasm during resection of lateral bladder wall tumors along with lower frequency of arterial hypotension, sinus bradycardia, as well as a reduction of the time spent in the operating room.

About the Authors

I. A. Rychkov
Blokhin Russian Oncology Research Center
Russian Federation

Ivan A. Rychkov - Doctor of Anesthesiology and Intensive Care Department.

24, Kashirskoye Highway, Moscow, 115478.

Fax: +7 (499) 324-19-30.



R. V. Gаryaev
Blokhin Russian Oncology Research Center
Russian Federation

Roman V. Garyaev - Doctor of Medical Sciences, Doctor of Anesthesiology and Intensive Care Unit.

24, Kashirskoye Highway, Moscow, 115478

Fax: +7 (499) 324-19-30.



References

1. Akkaya T., Ozturk E., Comert A. et al. Ultrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach. Anesth. Analgesia, 2009, vol. 108, no. 3, pp. 1037‒1041.

2. Anagnostopoulou S., Kostopanagiotou G., Paraskeuopoulos T. et al. Anatomic variations of the obturator nerve in the inguinal region: implications in conventional and ultrasound regional anesthesia techniques. Region. Anesth. Pain Med., 2009, vol. 34, no. 1, pp. 33‒39.

3. Bolat D., Aydogdu O., Tekgul Z.T. et al. Impact of nerve stimulator-guided obturator nerve block on the shor-term outcomes and complications of transurethral resection of bladder tumor: A prospective randomized controlled study. Can. Urol. Assoc. J., 2015, vol. 9, no. 11-12, pp. 780‒784.

4. Chen W.M., Cheng C.L., Yang C.R. et al. Surgical tip to prevent bladder perforation during transurethral resection of bladder tumors. Urology, 2008, vol. 72, pp. 667‒668.

5. Dagli R., Dadali M. Methods to prevent development of adductor muscle contraction during transurethral resection of lateral bladder wall tumors. Arch. Med. Science-Civilization Dis., 2018, vol. 3, pp. 64‒69.

6. Fujimoto M., Kawano K., Yamamoto T. The adequate rocuronium dose required for complete block of the adductor muscles of the thigh. Acta Anaesthesiol. Scandinavica, 2017, vol. 62, pp. 304‒311.

7. Fujiwara Y., Sato Y., Kitayama M. et al. Obturator nerve block using ultrasound guidance. Anesth. Analgesia, 2007, vol. 105, no. 3, pp. 888‒889.

8. García Rodríguez J., Jalón Monzón A., González Alvarez R.C. et al. An alternative technique to prevent of obturator nerve stimulation during lateral bladder tumors transurethral resection. Actas Urol. Esp., 2005, vol. 29, pp. 445‒447.

9. Gorgel S.N., Kose O., Horsanali O. et al. External iliac vein injury during the bipolar transurethral resection of bladder tumor: a case report. J. Med. Cases, 2015, vol. 6, no. 12, pp. 566‒567.

10. Honglin W. The research of intravenous injection of vecuronium in preventing obturator nerve reflex in the transurethral resection of bladder tumor of the lateral wall bladder tumor. J. Mudanjiang Med. University, 2013, vol. 3, pp. 21‒23.

11. Kuo J.Y. Prevention of obturator jerk during transurethral resection of bladder tumor. JTUA, 2008, vol. 19, pp. 27‒31.

12. Lin J.A., Nakamoto T., Yeh S.D. Ultrasound standard for obturator nerve block: the modified Taha’s approach. Brit. J. Anaesthesia, 2015, vol. 114, no. 2, pp. 337‒339.

13. Ong E.L., Chan S.T. Transurethral surgery and the adductor spasm. Ann. Acad. Med. Singapore, 2000, vol. 29, no. 2, pp. 259‒262.

14. Sinha S.K., Abrams J.H., Houle T.T. et al. Ultrasound-guided obturator nerve block an interfascial injection approach without nerve stimulation. Region. Anesth. Pain Med., 2009, vol. 34, no. 3, pp. 261‒264.

15. So P.C. Two case reports of obturator nerve block for transurethral resection of bladder tumor. Hong Kong Med. J., 2004, vol. 10, pp. 57‒59.

16. Soong J., Schafhalter-Zoppoth I., Gray A.T. Sonographic imaging of the obturator nerve for regional block. Region. Anesth. Pain Med., 2007, vol. 32, no. 2, pp. 146‒151.

17. Taha A.M. Ultrasound-guided obturator nerve block: a proximal interfascial technique. Anesth. Analg., 2012, vol. 114, no. 1, pp. 236‒239.

18. Tatlısen A., Sofikerim M. Obturator nerve block and transurethral surgery for bladder cancer. Minerva Urol. Nefrol., 2007, vol. 59, pp. 137‒141.

19. Walsh C.P. Surgical treatment of bladder cancer. In: Retik B.A., Vaughan D.E., Wein A.J., editors. Campbell’s urology. 9th ed. Philadelphia: Saunders 2007. pp. 2819‒2823.

20. Yıldırım I., Basal S., Irkilata H.C. et al. Safe resection of bladder tumors with plasma kinetic energy. UHOD, 2009, vol. 19, pp. 232‒236.

21. Yoshida T., Nakamoto T., Kamibayashi T. Ultrasound-guided obturator nerve block: a focused review on anatomy and updated techniques. BioMed Research International, 2017, article ID 7023750.

22. Yoshida T., Onishi T., Furutani K. et al. A new ultrasound-guided pubic approach for proximal obturator nerve block: clinical study and cadaver evaluation. Anaesthesia, 2016, vol. 71, pp. 291‒297.


Review

For citations:


Rychkov I.A., Gаryaev R.V. Obturator nerve block under double control with ultrasound and neurostimulation during transurethral resection of lateral bladder wall tumors. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2019;16(5):12-17. (In Russ.) https://doi.org/10.21292/2078-5658-2019-16-5-12-17



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ISSN 2078-5658 (Print)
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