title: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.
abstract: OBJECTIVE
  Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia.
  
  
  METHODS
  Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB.
  
  
  RESULTS
  The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032).
  
  
  CONCLUSIONS
  Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.
authors.affiliation: Department of Urology, Oncology Training and Research Hospital, Demetevler, 06530, Ankara, Turkey. fatihhizli33@yahoo.com.
authors.forename: F
authors.initials: F
authors.lastname: Hızlı
authors.affiliation: Department of Anesthesiology, Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Argun
authors.affiliation: Department of Anesthesiology, Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Güney
authors.affiliation: Department of Urology, Oncology Training and Research Hospital, Demetevler, 06530, Ankara, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Güven
authors.affiliation: Department of Urology, Oncology Training and Research Hospital, Demetevler, 06530, Ankara, Turkey.
authors.forename: A I
authors.initials: AI
authors.lastname: Arık
authors.affiliation: Department of Urology, Oncology Training and Research Hospital, Demetevler, 06530, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Başay
authors.affiliation: Department of Urology, Oncology Training and Research Hospital, Demetevler, 06530, Ankara, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Günaydın
authors.affiliation: Department of Urology, Oncology Training and Research Hospital, Demetevler, 06530, Ankara, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Başar
authors.affiliation: Department of Obstetrics and Gynecology, Turgut Ozal University Faculty of Medicine, Ankara, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Köşüş
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009776:Obturator Nerve / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Anesthesia; Inguinal approach; Intravesical approach; Obturator nerve block; Urinary bladder tumor