臨床医学ジャーナル

概要

Combination of Spinal Anesthesia and Obturator Nerve Block inTransurethral Resection of Bladder Tumor, Comparison between Nerve Stimulator and Ultrasonography

Houman Teymourian, Shayesteh Khorasanizadeh, Mohammad Reza Razzaghi and Yasmin Khazaie

Background: Genito-urinary system mostly develops cancers with bladder origin which can be treated in several ways. One of the most prevalent these ways are through the urethra (TURP). For anesthesia, general anesthesia or neuraxial methods can be used but the most common procedure is spinal anesthesia. The level of sensory block should reach to T10. Obturator nerves which are part of lumbar plexus innervate adductor muscles. The nerve in its route passes close to the ladder wall. Sometimes during cauterization of the tumor this nerve is stimulated, causing reflex adductor (Jump organs) despite the spinal anesthesia. Intraoperative complications of TURP include bleeding (sometimes too much). In some cases, adductor reflex can cause rupture of the bladder due to the movement of the patient. One of the useful measures to prevent this incident is to block the Obturator nerve separately.

Methods: 124 eligible subjects were assigned to two groups randomly. Ultrasound-guided Obturator nerve blocks in one group and the other with nerve locator, both received 10 cc of Lidocaine 1.5% with Epinephrine 1/200000. After spinal block with Bupivacaine 3 cc of 0.5% to obtain sensory level to 10, surgery is done. Presence or absence of adductor reflexes were recorded by the surgeon. Bladder perforation and bleeding during and after surgery were also recorded. The presence or absence of sensory or motor block residual was recorded in the next day.

Results: The incidence of adductor reflex (Jerking limbs during cauterization of the tumor) was significantly low in the ultrasound group than nerve location. The amount of bleeding and ruptured bladder in ultrasound group was significantly lower than in nerve locator. Any remaining blocks in any group after 24 hours were not present.

Conclusion: Based on the current study results, ultrasound-guided nerve block is more suitable than nerve locator for obturator block.