Comparison between Classic pubic approach and transurethral approach for prevention of obturator jerk in Resection of bladder tumor under subarachnoid block

Abstract

Background: Obturator jerk is a major problem during transurethral resection of bladder tumor which poses a major obstacle in complete resection of bladder tumor and increases risk of bladder perforation and vascular injury. Both Labat’s technique and transurethral injection of local anesthetic in bladder wall are used routinely for control of obturator jerk during transurethral resection of bladder tumor. Objectives: The primary objective of this study was to compare the efficacy of obturator block in controlling obturator jerk between anatomic landmark guided classical Labat’s technique and transurethral cystoscopic injection of local anesthetic into bladder wall in patients undergoing transurethral resection of bladder tumor under sub-arachnoid block at Combined Military Hospital (CMH), Dhaka. Materials and method: This Prospective randomized comparative study was performed in Combined Military Hospital (CMH), Dhaka from July 2018 to june 2019. Forty patients scheduled for transurethral resection of bladder tumor under sub-arachnoid block belonging to ASA class I, II and III were included in the study and randomly divided into two groups with 20 patients in each group. In Group A (n= 20) Anatomic landmark guided classical obturator block was employed using inj. Lignocaine 3 mg/kg. In Group B (n=20), obturator block was employed by using transurethral cystoscopic injection of Lignocaine 3 mg/kg into bladder wall. The study population was observed for obturator block, duration of surgery, peroperative cardiovascular status, any complications, surgeons and patients satisfaction. Results were analyzed using chi-square and Student t tests as appropriate. Results: In present study, mean age & mean body weight were comparable in both the groups. Complete elimination of obturator jerk was observed in 80% cases of group A and 70% cases of group B. No strong jerk was seen in group A but 5% cases of group B showed strong obturator jerk. But no significant difference was seen in statistical analysis. Mean duration of surgery was 58.2 minutes in Group A and 59.5 minutes in Group B, which was not statistically significant. No significant difference was noted between the groups in terms of peroperative hemodynamic status, complication rate, surgeon and patient satisfaction. Conclusion: Though the results of Labat’s technique seems better than cystoscopic injection technique, but there was no statistically significant difference between the two groups in terms of efficacy of block, hemodynamic status, duration of surgery, complications, surgeons and patients satisfaction.

JBSA 2023; 36 (1) : 37-43