Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Urinary Bladder Neoplasms

Urologic Neoplasms

Urogenital Neoplasms

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Urinary Bladder Diseases

Urologic Diseases

Male Urogenital Diseases

Central Nervous System Depressants

All Drugs and Chemicals

Anticonvulsants

Anesthetics

Rocuronium

Propofol

Bromides

Neuromuscular Nondepolarizing Agents

Neuromuscular Blocking Agents

1. An I-gel mask is inserted for the mechanical ventilator of the patient who is sedated with propofol.
2. For the ultrasound-guided obturator nerve (ON) block, and needle tip gradually advanced to the anterior branch of the ON. The current intensity for the stimulation of ON starts at 1.0 mA (using the sequential electrical nerve stimulation mode), and the needle is advanced gradually to the location where the contraction of the adductor longus muscle (ALM) occurs at 0.3-0.5 mA.
3. After fixing the needle in that position, measure the current intensity.
4. Then, rocuronium (0.6 mg/kg) is administered under quantitative neuromuscular-blockade monitoring.
5. When the train-of-four count becomes 0, the current intensity is increased until the contraction of the ALM occurs.
6. The current intensity is measured when the contraction of the ALM occurs.

After measuring the initial current intensity, quantitative neuromuscular blockade monitoring is applied, and rocuronium (0.6 mg/kg) is administered.

Rocuronium Bromide

Measuring the minimum current intensity for the stimulation of the obturator nerve to show the contraction of the adductor longus muscle.

Nerve stimulator

Ki Tae Jung, M.D., Ph.D.

Su Yeon Cho, M.D.

The purpose of the present study was to find out the difference in current intensity required for nerve stimulation according to the presence or absence of neuromuscular blockade during the obturator nerve block procedure for TURP.

During the transurethral resection of bladder tumors (TURBT) procedure under spinal anesthesia, the obturator nerve block is required to prevent the accidental movement of adductor longus muscles by electrical stimulation. However, during general anesthesia, the contraction of the adductor longus muscle would be lost due to deep neuromuscular blockade. However, some reports showed that the contraction of the adductor longus muscle occurs even in the deep neuromuscular blockade.

The current intensity for the nerve stimulation during nerve block is 0.3--0.5 mA when the needle tip is near the nerve. However, it is still unknown what current intensity is required to show the contraction of the adductor longus muscle when the patient is in a deep neuromuscular blockade.

Therefore, in this study, investigators aimed to determine the difference in current intensity required for nerve stimulation according to the presence or absence of neuromuscular blockade during obturator nerve block for TURP. In addition, investigators aimed to determine that the obturator nerve block is required during the TURP procedure in patients with deep neuromuscular blockade during general anesthesia.

Patients undergoing TURP procedure under general anesthesia

Current Intensity for the Obturator Nerve Block

The Difference in the Current Intensity for the Obturator Nerve Block According to the Presence or Absence of Neuromuscular Blockage

The current intensity for the stimulation of the obturator nerve starts at 1.0 mA (using the sequential electrical nerve stimulation mode), and the needle is advanced gradually to the location where the stimulus response occurs at 0.3-0.5 mA. After fixing the needle position in a position where contraction of the adductor longus muscle responds to the minimum current intensity, measure the current intensity.

After administration of rocuronium (0.6 mg/kg), when the train-of-four count becomes 0, the current intensity for the stimulation of the obturator nerve is increased until the contraction of the adductor longus muscle occurs. The current intensity is measured when the contraction of the adductor longus muscle occurs.

After administration of rocuronium (0.6 mg/kg), the quantitative neuromuscular blockade monitoring using train-of-four is observed with 12 seconds interval. At each time point, the current intensity for the obturator nerve is increased until the contraction of the adductor longus muscle occurs. The current intensity at each time point is measured.

Chosun University Hospital

Professor

Lateral wall urinary bladder tumors are resected transurethrally without obturator nerve block or relaxation under general anesthesia. If resection not possible because of adductor muscle contraction, patients undergo relaxation.

Bipolar transurethral resection of the urinary bladder (PlasmaKinetic, Gyrus, Fresenius)

Lateral wall urinary bladder tumors are resected transurethrally without obturator nerve block or relaxation under general anesthesia. If resection is not possible because of adductor muscle contraction, patients are treated by bipolar resection. If this is still not possible, they undergo relaxation.

Monopolar transurethral resection of the urinary bladder (Storz GmbH &Co., Erbotom, Purisole)

Daniel S Engeler, MD

This is a single-center, prospective, randomized, controlled trial comparing two established transurethral electrical resection methods of urinary bladder tumors regarding their risk of stimulating the obturator nerve.

One of the major safety issues with transurethral resection is bladder perforation as a consequence of obturator nerve stimulation followed by muscle contraction of. This is mostly a risk of resection of lateral bladder wall tumors near the course of the obturator nerve. It has been advocated that bipolar may be superior to monopolar resection, based on its different electrical properties. This is an important safety aspect for the patient.

Main study question: In patients with lateral wall urinary bladder tumors, is bipolar superior to monopolar transurethral electroresection regarding risk of stimulation of the obturator nerve without preoperative nerve block?

Safety Study of Bipolar Versus Monopolar Transurethral Resection of Bladder Tumors

Transurethral Resection of Bladder Tumors Without Obturator Nerve Block or Relaxation: Extent of Adductor Muscle Contraction With Monopolar Versus Bipolar Resection Technique

Successful resection of the neoplasm without relevant stimulation of the obturator nerve and consecutive contraction of the ipsilateral adductor muscles

Degree of severity of the complications (perforation of the bladder, intraoperative bleeding, postoperative bleeding, others) according to the Clavien-classification

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Current Intensity for the Obturator Nerve Block	NCT05872451	Bladder Tumor	Rocuronium Brom... Nerve stimulato...	18 Years -	Chosun University Hospital
Safety Study of Bipolar Versus Monopolar Transurethral Resection of Bladder Tumors	NCT01446822	Neoplasm of Lat...	Bipolar transur... Monopolar trans...	18 Years -	Cantonal Hospital of St. Gallen
Safety Study of Bipolar Versus Monopolar Transurethral Resection of Bladder Tumors	NCT01446822	Neoplasm of Lat...	Bipolar transur... Monopolar trans...	18 Years -	Cantonal Hospital of St. Gallen

Spots Global Cancer Trial Database for obturator nerve