Comparison of efficacy of ultrasound-guided obturator nerve block versus pericapsular nerve group block in preventing adductor jerk in patients undergoing transurethral resection of postero-lateral bladder mass under spinal anaesthesia: A randomised, single-blinded, controlled study.

Abstract

Background and aims: Adductor jerk during transurethral resection of bladder tumour (TURBT) is a common complication caused by obturator nerve stimulation, particularly in tumours located on the lateral or posterolateral bladder wall. Obturator nerve block (ONB) is widely used to prevent this complication. The pericapsular nerve group (PENG) block is a newer regional technique that may also reduce adductor jerk by blocking branches of the obturator and accessory obturator nerves. This study compared the efficacy of ultrasound-guided PENG block and ONB in preventing adductor jerk during TURBT.

Methods: This prospective, single-blinded, randomised study included patients undergoing TURBT for posterolateral bladder tumours under spinal anaesthesia. Patients received either ultrasound-guided ONB or PENG block. The primary outcome was the prevention of adductor jerk. Secondary outcomes included conversion to general anaesthesia, bladder perforation, postoperative pain scores, and quadriceps muscle strength.

Results: Sixty-two patients were analysed, with 31 patients in each group. The incidence of adductor jerk was similar between groups using Fisher's exact test (P = 1.000). Numerical Rating Scale scores at 6 hours were significantly lower in the PENG block group (median: 3.00 [2.00-3.00]) compared to the ONB group (median: 4.00 [3.00-4.00]), and this difference was statistically significant (Mann-Whitney U = 224, P < 0.001). Quadriceps muscle strength at 6 hours was comparable between groups with a median score of 5.00 in both groups, and the difference was not statistically significant (Mann-Whitney U = 418, P = 0.130). No bladder perforation was observed in either group.

Conclusion: Ultrasound-guided PENG block is comparable to ONB in preventing adductor jerk during TURBT and provides better postoperative analgesia.