A comparative analysis of proximal obturator nerve block versus general anesthesia in transurethral resection of bladder tumor: Prospective exploratory study.

Abstract

Introduction: Transurethral resection of bladder tumor (TURBT) harbors the risk of intraoperative obturator jerks in lateral wall tumors due to obturator nerve stimulation, resulting in bladder perforation. This study aims to compare the safety and efficacy of ultrasound-guided proximal obturator nerve block (PONB) with regional anesthesia (RA) versus general anesthesia (GA) during bipolar TURBT.

Methods: This prospective observational study enrolled 131 patients with lateral or posterolateral bladder tumors over 1.5 years. Patients were divided into two groups: Group I received PONB + RA (n = 63), while Group II received GA (n = 68). In Group I, 9 patients received unilateral (IA) and 54 bilateral PONB (IB). The primary objectives were to compare the incidence of obturator jerks and bladder perforations. Secondary objectives included comparing time taken for anesthesia, surgery, and associated complications.

Results: Obturator jerks were observed in 60% of Group IA patients. Considering patient safety, the remaining 54 patients in Group I received bilateral PONB. Only 5% of patients in IB had obturator jerks. No obturator jerk was seen in the GA group. No patient had bladder perforation. Surgery and anesthesia times were 32 ± 6 min and 63 ± 13 min in Group IA, 37 ± 5 min and 65 ± 10 min in Group IB, and 28 ± 5 min and 64 ± 15 min in Group II, respectively, all statistically nonsignificant.

Conclusion: Bilateral PONB significantly reduced obturator jerks compared to unilateral PONB providing similar safety and efficacy as GA. It is a viable alternative for patients unfit for GA.