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Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB.

Authors
 Youn Yi Jo ; Eunkyeong Choi ; Hae Keum Kil 
Citation
 Korean Journal of Anesthesiology, Vol.61(2) : 143~147, 2011 
Journal Title
 Korean Journal of Anesthesiology 
ISSN
 2005-6419 
Issue Date
2011
Abstract
BACKGROUND: During transurethral resection of bladder tumors (TURB) under spinal anesthesia, electrical resection of the lateral wall mass may cause violent adductor contraction and possible inadvertent bladder perforation. Therefore, obturator nerve block (ONB) is mandatory after spinal anesthesia to avoid adductor muscle contraction. We compared the success rate and efficacy of an inguinal approach, to a pubic approach for ONB. METHODS: One hundred and two patients who required ONB undergoing TURB with spinal anesthesia were included in this study. After spinal anesthesia, ONB was performed with an inguinal approach (Group I, n = 51) or pubic approach (Group P, n = 51) using a nerve stimulator. In the pubic approach, a needle was inserted at a point 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle. For the inguinal approach, a needle was inserted at the midpoint of the femoral artery and the inner margin of the adductor longus muscle 0.5 cm below the inguinal crease. If the adductor contracture had not occurred by the 3rd attempt, it was defined as a failed block. Puncture frequency, success rate, anatomical characteristics, and the presence of adductor muscle contraction during operation were evaluated. RESULTS: The success rate of ONB was higher in group I compared to group P (96.1% vs. 84.0%, P = 0.046) and the frequency of needle attempts was lower in group I than in group P (1.8 ± 0.9 vs. 1.3 ± 0.6, P = 0.01). CONCLUSIONS: The inguinal approach for ONB appears to be technically easier and offers certain anatomical advantages when compared to the pubic approach.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/94290
DOI
10.4097/kjae.2011.61.2.143
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Anesthesiology and Pain Medicine
Yonsei Authors
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