Transüretral Mesane Tümörü Rezeksiyonunda Addüktör Spazmını Önlemek İçin Levobupivakain ile Obturator Blok Uygulaması

Abstract

Objective: Adductor spasm can occur during transurethral resection of bladder tumour (TUR-BT) due to the stimulation of obturator nerve and can cause involuntary movement of legs, incomplete resection, bladder perforation and secondary extravesical dissemination of neoplastic cells. In this study we aimed to prevent adductor spasm and associated complications by obturator block with levobupivacain in patients with spinal anesthesia during TUR-BT for lateral wall tumors of the bladder. Material and Methods: Sixty 18-80 year-old patients, graded as ASA (American Society of Anestesiologists) I-III and scheduled for transuretral resection for lateral wall tumor of the bladder, were recruited for this study. Thirty patients, randomized as group S, received only spinal anesthesia and 30 patients randomized as group SOB, received spinal anesthesia and obturator block. Using a 22 G 50 mm insulated needle, 2 Hz, 0.5 mA electrical stimulation, with a pulse duration of 0.1 ms was applied, until the adductor muscle contractions were evoked. The local anesthetic solution 5 mL 7.5% levobupivacaine (37.5 mg) plus 5 mL 0.9% NaCl (Levobupivacaine 3.75%) was injected. Surgery was allowed after the spinal sensory block reached the T10 dermatome for all patients. Any adductor spasm occurring during surgery was recorded. Occurence of adductor muscle spasm and patient and surgeon satsifaction was evaluated. Results: Surgeon satisfaction was significantly higher in Group OBS (p<0.001) compared to Group S. Adductor spasm incidence was higher in Group S [25/30 (83%)] patients than in Group OBS [2/30 (6.7%)] patients (p<0.001). Conclusion: Obturator nerve block using levobupivacaine is effective in preventing adductor spasm in transurethral resection of lateral wall bladder tumours.