The optimal method of anesthesia for transurethral resection of a lateral bladder wall

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Abstract

In our prospective randomized study, 130 patients underwent a transurethral resection (TUR) because a neoplasm was located on the side wall of the bladder. In the neurostimulation (NS) group (n = 50), a spinal anesthesia with an obturator nerve block was made under the control of a neurostimulation; in the ultrasound (US) + NS group (n = 50), a spinal anesthesia with an obturator nerve block was made under the double control of ultrasound navigation and neurostimulation; in the general anesthesia (GA) group (n = 30), a general anesthesia with a deep myoplegia was made.

Results: The obturator nerve reflex was recorded for three (6%) patients from the NS group (p < 0.001); it caused a bladder perforation in one patient. The frequency of a sinus bradycardia in the NS (18%) and US + NS (20%) groups was lower than in the GA (43%) group, p = 0.008. Arterial hypotension was observed only in the OA group for 8 (27%) patients (p < 0.001). In the NS and US + NS groups, the patient’s time in the surgery room was significantly less (p < 0.001) than in the OA group averaging 48.36 ± 17.58 min and 50.82 ± 23.6 min, respectively.

Conclusion: The combination of a spinal anesthesia with obturator nerve block under the dual control of an ultrasound navigation and a neurostimulation can be considered as a reliable and safe method of an anesthetic maintenance of the TUR on the wall of the bladder. If it is impossible to provide such a control over the implementation of the blockade, it is necessary to resort to a GA with a deep myoplegia.

About the authors

Ivan A. Rychkov

N.N. Blokhin National Medical Research Center of Oncology of the Health Ministry of Russia

Author for correspondence.
Email: ivanmma@rambler.ru
ORCID iD: 0000-0001-6608-1163

anesthesiologist of the department anesthesiology and intensive care

Russian Federation, 115478, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Obturator nerve block under the control of nerve stimulator

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3. Fig. 2. Location of the transducer. The puncture site is located 1.5–2 cm from above the anterior side of the transducer (white point)

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4. Fig. 3. Ultrasound image of the obturator nerve block: nerve is indicated by arrows. SPR – superior pubic ramus; OE – obturator externus muscle; PE – pectineus muscle

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