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MINERVA UROLOGICA E NEFROLOGICA
A Journal on Nephrology and Urology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Minerva Urologica e Nefrologica 2007 June;59(2):137-41
Obturator nerve block and transurethral surgery for bladder cancer
Tatlisen A., Sofikerim M.
Department of Urology Erciyes University School of Medicine
Aim. The obturator nerve may be accidentally stimulated during transurethral resection of lateral bladder wall tumors, causing adductor spasms. In this study, we evaluated the results of obturator nerve block (ONB) produced via a blind anatomical approach.
Methods. Between April 2004 and April 2006, 114 patients with bladder tumors located on the lateral bladder wall had undergone transurethral resection of the bladder tumor (TUR-BT) at our clinic. Sixty-three patients with adductor spasms received local anesthetic ONB; no adductor spasms were observed in the remaining 51 patients. ONB was obtained with 10 mL of 1% prilocaine infiltrated through a 22 G spinal needle using a blind anatomical approach.
Results. Two of the 63 patients were excluded from the study due to bladder wall perforations caused by adductor spasms. Successful ONB was performed unilaterally in 61 patients. Muscle spasms were absent in 59 of the 61 patients (97%). In 2 patients receiving spinal anesthesia, and in whom total resection of bladder tumors was performed, adductor muscle spasms were seen during deep resection of the tumor bed, which prevented surgery from proceeding further.
Conclusion. ONB for the prevention of adductor spasms is a useful technique for the prevention of deep and uncontrolled cuts in the dorso-lateral part of the bladder wall during TUR-BT. The blind anatomical approach is a simple and easy procedure, with a high success rate.