Obturator Nerve Block in Transurethral Resection of Bladder Tumor: A Comparative Study by two Techniques

CONTEXT: Sparing of obturator nerve is a common problem encountered during transurethral resection of bladder tumor (TURBT) under spinal anesthesia. AIMS: To evaluate and compare obturator nerve block (ONB) by two different techniques during TURBT. SETTINGS AND DESIGN: This is prospective observational study. SUBJECTS AND METHODS: Forty adult male patients from the American Society of Anesthesiologists Class I–IV planned to undergo TURBT under spinal anesthesia were divided into two groups of twenty each. In one group, ONB was performed with nerve locator. In other group, transvesical nerve block was performed with a cystoscope. The primary endpoints of this study were the occurrence of adductor reflex, ability to resect the tumor, and number of surgical interruptions. A number of transfusions required and bladder perforation were the secondary endpoints. RESULTS: There was statistically significant difference between the groups for resection without adductor jerk, resection with a minimal jerk, and unresectable with high-intensity adductor jerk. Bleeding was observed in both groups and one bladder perforation was encountered. CONCLUSIONS: We conclude that ONB, when administered along with spinal anesthesia for TURBT, is extremely safe and effective method of anesthesia to overcome adductor contraction. ONB with nerve locator appears to be more effective method compared to the transvesical nerve block.