A COMPARATIVE STUDY BETWEEN CLASSIC AND INTERADDUCTOR APPROACH OF OBTURATOR NERVE BLOCK WITH ROPIVACAINE IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF BLADDER TUMOUR UNDER SPINAL ANAESTHESIA.

Abstract

Background: The most signicant use of ONB i.e., obturator nerve block is to prevent adductor muscle contraction associated with Transurethral resection of bladder tumours (TURBT). Adductor jerk during TURBT may cause serious injury to urinary bladder like laceration with involvement of blood vessels, severe bleeding, bladder wall tear and perforation and even partial resection of bladder tumour due to frequent distraction and interruption to the surgeon.1 So, there is need for evaluation and comparison of different techniques of ONB in view of safety and efcacy. We have conducted a randomized clinical study to compare the classic pubic and inter adductor approach for ONB with spinal anaesthesia for transurethral resection of bladder wall tumour masses. Method: A total number of 50 patients of either sex of ASA physical status I or II, of age group 30-75 years, who were posted for TURBT operation under spinal anaesthesia, were included in this study. A Prospective single blind randomised controlled trial and cross over study was conducted. Peripheral nerve stimulator to localize the nerve and Inj. Ropivacaine 0.5% ,15 ml on each side was used in this study. Result: The overall success rate in classic pubic approach was slightly lower than interadductor approach which was statistically insignicant. There were more instances of vessel puncture in pubic approach, which was statistically signicant (p value = 0.016). There was no incidence of other signicant complications. Conclusion: In terms of ease of obturator nerve block and incidence of complications the interadductor approach is better than classic pubic approach.