Efficacy of USG Guided Obturator Block to Prevent Obturator Jerk during TURBT Operation

Abstract

Background: The obturator nerve, from lumbar segments L2-L4, innervates thigh adductor muscles. During transurethral procedures, its accidental stimulation can cause "obturator jerks," risking complications like bladder perforation. To prevent this, obturator nerve blocks (ONB) are used with spinal anesthesia in TURBT, with ultrasound-guided ONB preferred for precision and safety. Aim of the study: This study aims to evaluate the efficacy of ultrasound-guided obturator nerve blocks in preventing obturator jerk, thereby enhancing surgical safety and outcomes for patients undergoing TURBT operation. Methods: This prospective observational study was conducted at the Department of Surgery, Shahid Sk. Abu Naser Specialized Hospital, Khulna Medical College Hospital and two private Hospitals, Khulna, Bangladesh from January 2019 to December 2023. Using purposive sampling, 65 patients with endovesical tumors on the lateral and posterolateral bladder walls scheduled for TURBT were recruited. Inclusion criteria were patients aged 31-70 with ASA I-III classification. Exclusion criteria included inguinal lymphadenopathy, obturator nerve injury, coagulation disorders, infection, or allergy to local anesthetics. Spinal block anesthesia was administered, and the obturator nerve was visualized via ultrasound for precise anesthetic deposition. Data on demographics, surgery details, and outcomes were collected and analyzed using SPSS version 26. Result: The study included 65 participants with a mean age of 55.58±6.75 years. The majority were males (70.77%) and aged 51–60 years (44.62%). The mean BMI was 23.41±2.36 kg/m², with most patients classified as ASA II (63.08%). The obturator nerve block procedure involved identifying key thigh muscles and the anterior branch of the obturator nerve. Motor block onset averaged 13.67±1.25 minutes, with a success rate of 78.46%. Surgery duration averaged 38.18±5.79 minutes, with 76.92% completed within 30–45 minutes. ...