title: Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB.
abstract: BACKGROUND
  During transurethral resection of bladder tumors (TURB) under spinal anesthesia, electrical resection of the lateral wall mass may cause violent adductor contraction and possible inadvertent bladder perforation. Therefore, obturator nerve block (ONB) is mandatory after spinal anesthesia to avoid adductor muscle contraction. We compared the success rate and efficacy of an inguinal approach, to a pubic approach for ONB.
  
  
  METHODS
  One hundred and two patients who required ONB undergoing TURB with spinal anesthesia were included in this study. After spinal anesthesia, ONB was performed with an inguinal approach (Group I, n = 51) or pubic approach (Group P, n = 51) using a nerve stimulator. In the pubic approach, a needle was inserted at a point 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle. For the inguinal approach, a needle was inserted at the midpoint of the femoral artery and the inner margin of the adductor longus muscle 0.5 cm below the inguinal crease. If the adductor contracture had not occurred by the 3rd attempt, it was defined as a failed block. Puncture frequency, success rate, anatomical characteristics, and the presence of adductor muscle contraction during operation were evaluated.
  
  
  RESULTS
  The success rate of ONB was higher in group I compared to group P (96.1% vs. 84.0%, P = 0.046) and the frequency of needle attempts was lower in group I than in group P (1.8 ± 0.9 vs. 1.3 ± 0.6, P = 0.01).
  
  
  CONCLUSIONS
  The inguinal approach for ONB appears to be technically easier and offers certain anatomical advantages when compared to the pubic approach.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science Gil Medical Center, Incheon, Korea.
authors.forename: Youn Yi
authors.initials: YY
authors.lastname: Jo
authors.forename: Eunkyeong
authors.initials: E
authors.lastname: Choi
authors.forename: Hae Keum
authors.initials: HK
authors.lastname: Kil