Abstract

This was a prospective randomized study, conducted to evaluate the efficacy of Obturator Nerve blocks using nerve stimulator in Transurethral Resection of Bladder Tumor (TURBT) under spinal anaesthesia.

Aim and Objectives: To study the effectiveness of Obturator nerve block given by nerve stimulation technique to block the adductor jerk under spinal anaesthesia during Transurethral Resection of Bladder Tumor (TURBT).

Material and Methods:  Total 60 patients, aged between 45 and 70 years belonging to ASA physical status I-III, having inferolateral wall and bladder neck tumors that were scheduled for transurethral resection of bladder tumor at risk for electrical stimulation as determined by the attending surgeon and divided them into Group I and II. Patient in Both Group I   and Group II received Inj Bupivacaine (0.5% hyperbaric/ heavy) for subarachnoid block. In Group II patients, after spinal anaesthesia was given Unilateral or bilateral Obturator Nerve block was given depending on the site of tumor by Nerve Stimulation technique using 10 ml of 0.75 % Ropivacaine. During the operative procedure, the primary endpoint of the study was resectability of the tumor whether it hampered or unhampered by adductor reflex under spinal anaesthesia. Complications like bleeding and bladder perforation were the secondary endpoints of this study.

Results: Only  5 (16.66%) patients  in Group I , which does not received the Obturater nerve block, have no or minimum   adductor muscle jerk in intraoperative period but 25 (83.33%) patients had significant adductor muscle jerk and required  general anaesthesia with muscle relaxation for continuation of procedure. In Group II in which the Obturator nerve block is given after spinal anaesthesia only one patient(3.33%) required general anaesthesia and 29 (96.66%) patients was operated in spinal anaesthesia with Obturator nerve block. The incidence of bladder perforation which is a serious complication was 6.6% in Group I and there is no incidence of bladder perforation in Group II. Total requirement of blood product are significantly more in Group I (16.66%) as compare to Group II (2.66%).

Conclusions: Transurethral resection of the bladder tumor can be perform successfully under spinal anaesthesia, supplemented with Obturater Nerve block using nerve stimulation technique with minimum side effect. Thus, Obturater nerve block has become an essential component of spinal anesthesia for TURBT.

Keywords: Transurethral resection of bladder tumor (TURBT), Adductor spasm, Obturator nerve block,  Spinal anaesthesia.