Outcomes of Ultrasound Guided Versus Cystoscopy Guided Obturator Nerve Block (Obn) In Transurethral Resection Of Bladder Tumour (Turbt)

Journal of Dhaka Medical College Pub Date : 2023-01-29 DOI:10.3329/jdmc.v30i2.56928

M. Zunaid, Taniza Jabin Zunaid, Gopal Deb, Shuchana Chakma, M. Kamal, Md. Mizanur Rahman, Rabeya Begum, Taneem Mohammad

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Abstract

Context: Selective obturator nerve block (ONB) limits obturator reflex, adductor contraction, and leg jerking in transurethral resection of bladder tumour (TURBT), which ultimately prevents complications such as bleeding, bladder perforation, or incomplete tumor resection. The present study aims to compare the effectiveness of two different techniques of obturator nerve block during TURBT. Methods: A prospective, observational study was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, between September 2018 and August 2019 to evaluate the effectiveness of ultrasound guided ONB versus cystoscopy guided ONB in TURBT operation. A total of 60 selected patients were randomly allocated into two groups: ultrasound guided ONB (group A) and cystoscopy guided ONB (group B) i.e. 30 in each group. Then onset of anesthesia (nerve block), tumour removal and patient outcome were assessed at different point during and after surgery. Results: Mean age of the patients was 54.7±8.53 years. In total, 34(57%) cases were male and 26(43%) were female. Male to female ratio was 1.3:1. In group A, 19(63.3%) patients had ASA II status and 11(36.7%) had ASA III status, while in group B, the numbers were 18(60%) and 12(40%) respectively. There was no significant difference in demographics and ASA status between two groups (P>0.05). Average onset of obturator nerve block was faster in group A (8.17±1.4 min) than group B (11.3±2.68 min), (P<0.001). Total resectability of tumours were achieved in 28(93.3%) in group A and 23(76.6%) in group B during operation (P<0.001), while 2(22.22%) and 7(77.77%) tumours had incomplete removal respectively (P<0.05). Among complications, adductor jerks were evident in 2(6.7%) and 7(23.3%), bladder perforation in 1(3.3%) and 4(13.3%), and bleeding in 1(3.3%) and 3(10.0%) cases in group A and group B respectively. The differences were statistically significant ((P<0.05). Conclusion: Although both techniques are safe and easy to perform, ultrasound guided ONB results in faster onset of block and better resectability of tumour with less complication over cystoscopy guided ONB. J Dhaka Med Coll. 2021; 30(2) : 208-213

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超声引导下与膀胱镜引导下闭孔神经阻滞(Obn)经尿道膀胱肿瘤切除术(Turbt)的疗效比较

背景:选择性闭孔神经阻滞(ONB)限制经尿道膀胱肿瘤切除术(TURBT)时的闭孔反射、内收肌收缩和腿部抽搐，最终防止出血、膀胱穿孔或肿瘤切除不全等并发症。本研究旨在比较两种不同的闭孔神经阻滞技术在TURBT手术中的有效性。方法:2018年9月至2019年8月在孟加拉国达卡医学院附属医院麻醉、镇痛、姑息和重症监护医学科开展前瞻性观察研究，评价超声引导下ONB与膀胱镜引导下ONB在TURBT手术中的效果。选择60例患者随机分为超声引导下的ONB组(A组)和膀胱镜引导下的ONB组(B组)，每组各30例。然后在手术中和手术后的不同时间点评估麻醉(神经阻滞)，肿瘤切除和患者预后。结果:患者平均年龄54.7±8.53岁。男性34例(57%)，女性26例(43%)。男女比例为1.3:1。A组ASA II状态19例(63.3%)，ASA III状态11例(36.7%)，B组分别为18例(60%)和12例(40%)。两组患者的人口学特征和ASA状态差异无统计学意义(P < 0.05)。A组闭孔神经阻滞平均起效时间(8.17±1.4 min)快于B组(11.3±2.68 min)，差异有统计学意义(P<0.001)。术中A组28例(93.3%)、B组23例(76.6%)肿瘤完全可切除(P<0.001)， 2例(22.22%)、7例(77.77%)肿瘤完全切除(P<0.05)。并发症中，A、B组分别出现明显内收肌痉挛2例(6.7%)、7例(23.3%)，膀胱穿孔1例(3.3%)、4例(13.3%)，出血1例(3.3%)、3例(10.0%)。差异有统计学意义(P<0.05)。结论:两种技术均安全易行，超声引导下的ONB比膀胱镜引导下的ONB起块更快，肿瘤可切除性更好，并发症更少。达卡医学院，2021;30(2): 208-213

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Journal of Dhaka Medical College

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