COMPARISON OF EASE OF BLOCK AND SUCCESS RATE OF INGUINAL AND CLASSIC APPROACHES OF OBTURATOR NERVE BLOCKUSING PERIPHERAL NERVE STIMULATOR IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF BLADDER TUMOURS INVOLVING LATERAL WALL UNDER SPINAL ANAESTHESIA.

Dr. Surabhi Varshney; Prof. Vinita Singh; Prof. Dinesh Kaushal

Volume : VI, Issue : VII, July - 2017

COMPARISON OF EASE OF BLOCK AND SUCCESS RATE OF INGUINAL AND CLASSIC APPROACHES OF OBTURATOR NERVE BLOCKUSING PERIPHERAL NERVE STIMULATOR IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF BLADDER TUMOURS INVOLVING LATERAL WALL UNDER SPINAL ANAESTHESIA.

Dr. Surabhi Varshney, Prof. Vinita Singh, Prof. Dinesh Kaushal

Abstract :

Introduction: Transurethral resection of bladder tumours (TURBT) involving lateral wall has high risk of obturator nerve stimulation during procedure leading to adductor spasm which can be avoided by selective obturator nerve block (ONB).The classic approach requires more skill and has increased chances of vascular injury. The inguinal approach is a safer alternative. This randomised study was conducted to compare ease of block and success rate between both approaches.

Methods:Total 50 patients scheduled to undergo TURBT having bilateral bladder wall tumours were enrolled for the study after ethical approval from Institutional Ethics Committee and written, informed consent from patients. Power 80%, confidence 95%. In all patients ONB was performed by classic approach on one side and inguinal approach on other side using a nerve stimulator after giving spinal anaesthesia. Primary criteria–ease of block and success rate, secondary criteria–complications were compared between both approaches. Wilcoxon signed rank test was used to compare ease of block and Chi square test to compare success rate and complications. P<0.05 was considered statistically significant.

Results: Ease of block (P<0.001) and success rate (P=0.001) were higher with inguinal approach whereas vascular injury (P=0.079) and intraoperative adductor spasm (P=0.008) were higher in classic approach.

Conclusion:The inguinal approach for ONB seems to be technically easier, safer and with higher success rate than classic approach.