Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia.
Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB.
The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032).
Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.
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Kobayashi M, Takeyoshi S, Takiyama R, Seki E, Tsuno S, Hidaka S, Fukuda H, Inada K (1991) A report on 107 cases of obturator nerve block. Masui 40(7):1138–1143
Rodríguez JG, Monzón AJ, Alvarez RCG et al (2005) An Alternative technique to prevent of obturator nerve stimulation during lateral bladder tumors transurethral resection. Actas Urol Esp 29:445–447
Kuo JY (2008) Prevention of obturator jerk during transurethral resection of bladder tumor. JTUA 19:27–31
Patel D, Shah B, Patel BM (2004) Contribution of obturator nerve block in the transüretral resection of bladder tumors. Indian J Anaesth 48:47–49
Tatlisen A, Sofikerim M (2007) Obturator nerve block and transurethral surgery for bladder cancer. Minerva Urol Nefrol 59:137–141
Chen WM, Cheng CL, Yang CR, Chung V (2008) Surgical tip to prevent bladder perforation during transurethral resection of bladder tumors. Urology 72:667–668
Yıldırım I, Basal S, Irkilata HC (2009) Safe resection of bladder tumors with plasma kinetic energy. Int J Hematol Oncol 19:232–236
Deliveliotis C, Alexopoulou K, Picramenos D (1995) The contribution of obturator nerve block in transurethral resection of bladder tumors. Acta Urol Belg 63:51–54
Augspurger RR, Donohue RE (1980) Prevention of obturator nerve stimulation during transurethral surgery. J Urol 123:170–172
Hradec E, Soukup F, Novak J, Bures E (1983) The obturator nerve block: preventing damage of the bladder wall during transurethral surgery. Int Urol Nephrol 15:149–153
Akata T, Murakami J, Yoshinaga A (1999) Life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block. Acta Anaesthesiol Scand 43:784–788
So PC (2004) Two case reports of obturator nerve block for transurethral resection of bladder tumor. Hong Kong Med J 10:57–59
Labat G (1928) Regional anesthesia; its technic and clinical application. W.B. Saunders, Philadelphia, pp 286–287
Wassef MR (1993) Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles. Reg Anesth 8(1):13–17
Ciechomski M, Jureczko L (2003) Mayzner-zawadzka e: evaluation of the adductor approach to the obturator nerve blockade in transurethral surgery. Eur J Anaesthesiol 30(Suppl):106
Khorrami MH, Javid A, Saryazdi H, Javid M (2010) Transvesical blockade of the obturator nerve to prevent contraction in transurethral bladder surgery. J Endourol 24(10):1651–1654
Yamauchi M, Sato Y (2008) Ultrasound-guided obturator nerve block. Masui 57(5):588–595
Sinha SK, Abrams JH, Houle TT, Weller RS (2009) Ultrasound-256 guided obturator nerve block: an intrafascial injection approach without nerve stimulation. Reg Anesth Pain Med 34(3):261–264
Hadzic A, Sala-Blanch X, Xu D (2008) Ultrasound guidance may reduce but not eliminate complications of peripheral nerve blocks. Anesthesiology 108:557–558
Kuo Junne-yih (2008) Prevention of obturator jerk during transurethral resection of bladder tumor. JTUA 19:27–31
Atanasoff PG, Weiss BM, Brull SJ (1996) Lidocaine plasma levels following two techniques of obturator nerve block. J Clin Anesth 8(7):535–539
Cesur M, Erdem AF, Alici HA, Yapanoglu T et al (2008) The role of succinylcholine in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors. Saudi Med J 29(5):668–671
Special thanks to associated professor Dr. Aydin Köşüş for his valuable analysis and support in this paper’s statistical analysis and comment.
Conflict of interest
The Research Ethics Committee of the Kırıkkale University Faculty of Medicine reviewed and approved this study, which has been conducted following Helsinki recommendations and European Union and Turkish regulations.
The patient’s consent has been obtained.
The Editor-in-Chief has retracted this article because it shows significant overlap with a previously published article by Pladzyk et al. F. Hızlı, G. Argun, O. Güven, and H. Başar agree with this retraction. İ. Güney, A. İ. Arık, S. Başay, H. Günaydın, and A. Köşüş have not responded to any correspondence from the publisher about this retraction.
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Hızlı, F., Argun, G., Güney, İ. et al. RETRACTED ARTICLE: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial. Ir J Med Sci 185, 555–560 (2016). https://doi.org/10.1007/s11845-015-1300-y
- Urinary bladder tumor
- Obturator nerve block
- Inguinal approach
- Intravesical approach