Transvesical Blockade Of The Obturator Nerve To Prevent Adductor Contraction In Transurethral Bladder Tumors

Objective: To evaluate the efficacy of transvesical obturator nerve block (ONB) in the prevention of obturator nerve reflex and leg jerking during transurethral resection of bladder tumors (TURBT).Methods: A total of 47 patients (groupⅠ) were studied, in whom the transurethral resection of tumors on the posterolateral bladder wall were performed for scheduled. During the same time period, another two groups comprised 55 random patients (groupⅡ25, groupⅢ30) who had undergone transurethral resection of bladder tumor (TURBT) served as controls. The age range, size and number of tumors were comparable in three groups of patients. All the patients were diagnosed as bladder tumor in the lateral wall by routine testing, B-type Ultrasound or CT, urinary cytology, cystoscopy and biopsy. GroupⅠreceived transvesical ONB and epidural anesthesia (EA) together. GroupⅡreceived general anesthesia (GA) and muscular relaxants. GroupⅢreceived EA and ONB under the peripheral nerve stimulator together. The patients underwent TURBT using monopolar cautery. Incidence of leg jerking and other complications, the time of ONB manipulated, the average duration of postoperation hospital stay and the average cost of hospital stay were registered and compared in these three groups.Results: Patients' demographics including age, gender, number and size of tumor in the 3 groups were comparable(P>0.05). 3 out of 47 patients in the groupⅠexperienced a little symptom of adductor spasm which didn't disturb the operation; the time of ONB manipulated in the groupⅠwas 5.40±1.33 min. In the groupⅡ, 2 out of 25 patients experienced a little symptom of adductor spasm which didn't disturb the operation; 3 out of 25 patients had lung infection in the postoperation. In groupⅢ, 5out of 30 patients experienced adductor spasm, of whom 1 case resulted bladder perforation and 3 cases had to resorted to general anesthesia (GA) and muscular relaxants ; 1 case had urinary tract infection and 1 case had incision bleeding in the postoperation; the time of ONB manipulated was 12.17±1.80 min. There were no significant differences in ONB effectiveness between the groupⅠand groupⅡ.Comparing groupⅠwith GroupⅢ, transvesical ONB effectively decreased leg jerking during TURBT (0% vs 10%; P<0.05) and less time of ONB manipulated (5.40±1.33 vs 12.17±1.80;p<0.05). The average duration of postoperation hospital stay in 3 groups was 3.10±1.15 days, 7.22±1.08 days and 5.33±1.41 days respectively. The average cost of hospital stay in 3 groups was$ 6114.10±527.25,$8057.33±970.46,$10069.54±1099.90 respectively.Conclusion: Transvesical blockade of the obturator nerve is a highly effective method in TURBT. It has the advantage of using a simple-device, being easy to maneuver, having fewer complications, and is low in cost. It can be widely used in clinical practice in transurethral resection of tumors on the posterolateral bladder wall.