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ULTRASOUND-GUIDED OBTURATOR NERVE BLOCK FOR TRANSURETHRAL RESECTION OF BLADDER TUMOUR - INTERADDUCTOR APPROACH
ESRA Academy. Dobronska K. Sep 8, 2016; 138303; 0130 Topic: Peripheral Nerve Blocks
Karolina Dobronska
Karolina Dobronska

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Abstract
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Background and Aims:

The aim of the study was to evaluate the safety and effectiveness of ultrasound-guided ONB as a method of preventing adductor muscles contraction during transurethral resection of bladder tumour (TURBT) localized on the lateral wall. 

Methods:

Due to prior spinal anaesthesia the patient does not feel uncomfortable during the blockade and the interadductor approach gives the possibility to perform it in the lithotomy position. For nerve identification a linear transducer is used. It is placed next to the grain just under the adductor longus tendon. Between adductor longus and brevis, in fascial plane, an anterior branch of obturator nerve should be visualized. The needle is advanced in an out-of-plane trajectory. If there are problems with nerve identification the anaesthetic is injected in fascial plane between adductors muscles - longus and brevis.10 ml of 2% lidocaine is used for single block and 2 x 10 ml of 2% lidocaine with epinephrine when bilateral one is needed.

Results:

It is an interim analysis. A 56 ONB were performed in 50 patients (age 35-90) with TURBT under spinal anaesthesia. The nerve was visualized in 78%. The efficacy of ONB was 92,8%. The failure of ONB was irrespectively of nerve visualization. There were no urinary bladder perforation; neither hematomas nor neurological adverse events were observed.

Conclusions:

The described method offers a high rate of efficacy and ensures safe conditions for the resection of a tumor located on the inferolateral wall of the urinary bladder. The risk of complication is low.
Clinicaltrials.gov NCT02696733

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