Neoplasms

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Urinary Bladder Neoplasms

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Female Urogenital Diseases and Pregnancy Complications

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Central Nervous System Depressants

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Anesthetics

Levobupivacaine

Patients who underwent obturator nerve block with spinal anesthesia prior to TURBT

Patients who underwent spinal anesthesia prior to TURBT

Following the confirmation of spinal anesthesia level in the patients in the ONB group while in the lithotomy position, ONB was applied unilaterally or bilaterally, depending on the tumor position. A needle with a nerve stimulator was advanced vertically 2 cm below and 2 cm from the pubic tubercle. The needle is inserted through the skin and into the lower ramus of the pubic bone. When contraction was observed in the adductor muscle groups and the aspiration was negative, 10 mL 0.25% levobupivacaine at 0.3-0.5 mA was administered. The operation was started 10 minutes after the injection. TURBT operations were performed with a 30 degree optic and a 26 F bipolar resectoscope. All spinal anesthesia and ONB procedures were performed by the same anesthesia team. All TURBT operations were performed by the same surgeon.

Nerve Stimulator-guided Obturator Nerve Block

Ali Kaan Yildiz

In this prospective randomized controlled study, the effects of obturator nerve block (ONB) on obturator reflex, incomplete resection, perforation, tumor recurrence and progression, presence of muscle tissue in the specimen, need for second transurethral resection of bladder tumours (TURBT) and postoperative complications were investigated in patients who underwent TURBT for intermediate and high risk lateral wall non-muscle invasive bladder tumours (NMIBC).

Bladder cancer is among the ten most common types of cancer in the world, with about 550,000 new cases per year. According to GLOBOCAN (Global Cancer Incidence, Mortality and Prevalence) data, bladder cancer accounts for 3% of cancer diagnoses worldwide. It is more common, especially in developed countries. A total of 90% of bladder cancer diagnoses are made in people 55 years of age or older, and the disease is four times more common in men than in women. NMIBC are divided into four groups as low-medium-high and very high risk according to EORTC (European Organization for Research and Treatment of Cancer). Early recurrence was reported as 15%, late recurrence as 25% and progression as 9% with BCG treatment in medium and high risk NMIBC. TURBT is the basic approach in diagnosis and treatment.

The obturator nerve passes through the obturator foramen of the pubis and innervates the adductor muscles of the thigh. It lies within the pelvic cavity close to the prostatic urethra, bladder neck and inferolateral bladder wall. In TURBT, when the bladder is filled with irrigation fluid, the obturator nerve is very close to the bladder sidewall. While performing TURBT of lateral wall bladder tumors, neighboring obturator nerve stimulation may occur during surgical resection, resulting in adductor contraction and leg jerking. This condition, called the obturator reflex, occurs between 55.3% and 100% of lateral bladder tumors.

Serious complications can occur in TURBT, one of which is bladder perforation that may require laparotomy and open repair. Perforation is also associated with poor patient outcomes due to the spread of the tumor into the abdominal cavity and the inability to apply single immediate instillation of intravesical chemotherapy. One of the most important factors affecting the success of TURBT is the presence of residual tumor as a result of incomplete resection. Incomplete resection is associated with both general recurrence and particularly local recurrence, as well as shortening disease-free survival. One of the most important indicators of complete resection is the presence of the detrusor muscle in the TURBT specimen. However, in 10% of all cases, it has been reported that there is no detrusor muscle tissue in the TURBT specimen. Various methods such as administration of muscle relaxants under general anesthesia, less filling of the bladder, reduction of electric current, using a 90-degree classical loop, using bipolar plasmakinetic energy and performing tumor resection with small pieces have been proposed in order to prevent the failure and complications due to obturator reflex that may occur in TURBT.

In combination with spinal anesthesia, ONB is one of the most effective methods used to inhibit the obturator reflex. The importance of spinal anesthesia has increased especially due to the COVID-19 outbreak. Surgery under local / regional anesthesia is recommended as much as possible, especially during the pandemic process, compared to general anesthesia. In this way, it is aimed to reduce the risk of aerosol generating procedures and subsequent viral transmission. ONB has gained more importance in recent years as a result of being performed together with spinal anesthesia.

Efficacy and Safety of Obturator Nerve Block During Transurethral Resection on Non-muscle Invasive Intermediate and High Risk Lateral Wall Bladder Tumours

Efficacy and Safety of Obturator Nerve Block During Transurethral Resection on Non-muscle Invasive Intermediate and High Risk Lateral Wall Bladder Tumours Comparing Nerve Stimulator-guided Obturator Nerve Block With Spinal Anaesthesia and Spinal Anaesthesia: A Prospective Randomized Controlled Study

Rate of patients who had an obturator reflex during the operation

Ankara Training and Research Hospital

Principal Investigator

In supine position, ultrasound probe will be placed on inguinal region, 2-3 cm below to the inguinal crease. Patients in this group will receive interfascial obturator nerve block under ultrasound guidance.

In supine position, the ultrasound probe will be placed on in inguinal region, 1-2 cm below to the inguinal crease to identiy the subpectineal area. Patients in this group will receive subpectineal obturator nerve block under ultrasound guidance.

Interfascial Injection on Ultrasound-guided Obturator Nerve Block

Interfascial Injection

Subpectineal Injection on Ultrasound-guided Obturator Nerve Block

Subpectineal Injection

This study aimed to assess the effectiveness of the ultrasound-guided interfascial injection approach with the subpectineal injection technique for obturator nerve block in bladder cancers undergoing transurethral resection of bladder tumor (TURBT) under spinal anesthesia.

Comparison of Interfascial Injection Versus Subpectineal Injection on Ultrasound-guided Obturator Nerve Block

The success or fail of the obturator nerve block will be conformed using nerve stimulator. Detecting muscles twitch will br considered to be a fail.

Number of adductor muscle spazms in each group will be noted during the intraoperative period.

Sensory block area will be evaluated by a pin prick at in the dermatomal areas related obturator nerve and branches.

Changes in overall satisfaction will be assessed using a 5 point Likert Scale ( 1-very dissatisfied, 2- dissatisfied, 3- neutral, 4-satisfied, 5 - very satisfied

Block performance time will be recorded from the time the first ultrasound image is obtained until the procedure is completed

Diskapi Teaching and Research Hospital

Principal investigator

In this study, the effectiveness of obturator nerve block added to spinal anesthesia in the operation of transurethral resection (TUR-M) of bladder lateral-infrolateral wall tumors on the obturator reflex and related complications was investigated.

Retrospective Evaluation of the Effect of Ultrasound-guided Obturator Nerve Block on Complications in Transurethral (TUR-M) Resection Surgery for Bladder Side Wall Tumors.

patient who underwent spinal anesthesia and obturator block

The patient group who underwent spinal anesthesia and obturator block and the group without obturator block

Erol Olcok Corum Training and Research Hospital

assistant professor

Prilocaine

spinal block will be performed to patients after monitoring

spinal block will be performed to patients after monitoring, and then the patients in the ONB block group will be given the appropriate position, with a USG-assisted distal approach, 5 cc %2 prilocain into the anterior and 5cc %2 prilocain into the posterior branch of the obturator nerve.

spinal block and obturator nerve block

serap diker, MD

feryal akçay, MD

Serap Diker, MD

Investigation of delay in postoperative mobilization due to motor block and complications related to block in patients who underwent USG-assisted obturator nerve block with distal approach

Obturator Block in Lateral Tumors of the Bladder: Does it Have Adverse Effects on Early Postoperative Mobilization?

Ankara City Hospital Bilkent

Anesthesiology and Reanimation

Anti-Arrhythmia Agents

Channel Blockers

Lidocaine

Patients scheduled for TUR for bladder tumor Intervention: uni-lateral obturator nerve block.

non-blocked obtorator side of each patient will be used as control

a uni-lateral obturator nerve block will be performed under ultrasound guidance- using 2% lidocaine for obtaining a short term block.

obturator nerve block

David Margel, MD, PhD

The aim of this study is to estimate the incidence rate of obturator nerve reflex and leg jerking during Transurethral Resections of Bladder Tumors (TURBTs), evaluate the efficacy of obturator nerve block in the prevention of inadvertent muscle spasm, and to identify predictors for both the jerking reflex and successful nerve block.

Study design: A single center single arm prospective study aiming to estimate the incidence rate of obturator nerve reflex and leg jerking during TURBTs, evaluate the efficacy of obturator nerve block (ONB) in the prevention of inadvertent muscle spasm, and identify predictors for both the jerking reflex and successful nerve block.

Study population: patients who are scheduled for TUR for bladder tumor, as standard care, who are willing and able to participate in the study

Intervention: a uni-lateral ONB (using Lidocaine 2%)

Study outline: Once in the operating room patients will be monitored by continuous electrocardiography, non-invasive arterial blood pressure measurement, and pulse oximetry in the usual manner. They will then undergo general or spinal anesthesia according to their preference and at the discretion of the treating anesthesiologist, without the use of muscle relaxants. As part of the study, a uni-lateral ONB will be performed under ultrasound guidance- using 2% lidocaine for obtaining a short term block, for the duration of the procedure itself. The non-blocked nerve will be used as control. The surgeon will be blinded as to the side in which the ONB has been performed. A catheter will be used to fill the bladder with saline to its full capacity. The inner wall of the bladder will then be stimulated to test for an obturator nerve reflex and leg jerking. Stimulation will be done using a trans-resectoscope and a single-twitch electrical current generated by a neuromuscular monitoring device, as previously described by Mihara et al. Four different bladder volumes will be tested. For each bladder volume, a reflex response on both sides will be documented and graded. The investigators will then proceed with a TUR in the usual manner.

Primary endpoints: frequency of obturator jerk reflex and efficacy of obturator nerve block

Prospective Clinical Trial - Obturator Reflex Predictors and Blockage

percentage of subjects for which the obtorator nerve block prevnted inadvertent obturator jerk

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Efficacy and Safety of Obturator Nerve Block During Transurethral Resection on Non-muscle Invasive Intermediate and High Risk Lateral Wall Bladder Tumours	NCT04885309	Bladder Cancer ... Bladder Cancer ...	Nerve Stimulato...	18 Years - 90 Years	Ankara Training and Research Hospital
Comparison of Interfascial Injection Versus Subpectineal Injection on Ultrasound-guided Obturator Nerve Block	NCT05540847	Bladder Neoplas...	Interfascial In... Subpectineal In...	18 Years -	Diskapi Teaching and Research Hospital
Retrospective Evaluation of the Effect of Ultrasound-guided Obturator Nerve Block on Complications in Transurethral (TUR-M) Resection Surgery for Bladder Side Wall Tumors.	NCT04995445	Efficacy of Per...		18 Years -	Erol Olcok Corum Training and Research Hospital
Obturator Block in Lateral Tumors of the Bladder: Does it Have Adverse Effects on Early Postoperative Mobilization?	NCT05652309	Obturator Nerve... Ultrasound Guid... Complications N...	spinal block an...	18 Years - 75 Years	Ankara City Hospital Bilkent
Retrospective Evaluation of the Effect of Ultrasound-guided Obturator Nerve Block on Complications in Transurethral (TUR-M) Resection Surgery for Bladder Side Wall Tumors.	NCT04995445	Efficacy of Per...		18 Years -	Erol Olcok Corum Training and Research Hospital
Prospective Clinical Trial - Obturator Reflex Predictors and Blockage	NCT02228330	Malignant Neopl...	obturator nerve...	18 Years -	Rabin Medical Center

Spots Global Cancer Trial Database for obturator nerve block