Shubhankar Gautam, Mittal Ankur, Panwar Vikas Kumar, Mandal Arup Kumar, Talawar Praveen
Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Indian J Urol. 2025 Apr-Jun;41(2):111-116. doi: 10.4103/iju.iju_254_24. Epub 2025 Apr 1.
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.
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.
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.
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.
经尿道膀胱肿瘤切除术（TURBT）因闭孔神经刺激，对于侧壁肿瘤存在术中闭孔肌反射的风险，可导致膀胱穿孔。本研究旨在比较双极TURBT期间超声引导下近端闭孔神经阻滞（PONB）联合区域麻醉（RA）与全身麻醉（GA）的安全性和有效性。
这项前瞻性观察性研究在1.5年期间纳入了131例患有侧壁或后外侧膀胱肿瘤的患者。患者分为两组：第一组接受PONB + RA（n = 63），而第二组接受GA（n = 68）。在第一组中，9例患者接受单侧（IA），54例接受双侧PONB（IB）。主要目标是比较闭孔肌反射和膀胱穿孔的发生率。次要目标包括比较麻醉、手术时间及相关并发症。
IA组60%的患者观察到闭孔肌反射。考虑到患者安全，第一组其余54例患者接受双侧PONB。IB组仅5%的患者出现闭孔肌反射。GA组未观察到闭孔肌反射。无患者发生膀胱穿孔。IA组的手术和麻醉时间分别为32±6分钟和63±13分钟，IB组为37±5分钟和65±10分钟，第二组为28±5分钟和64±15分钟，均无统计学差异。
与单侧PONB相比，双侧PONB显著减少了闭孔肌反射，提供了与GA相似的安全性和有效性。对于不适合GA的患者，它是一种可行的替代方案。
