PTU - Polskie Towarzystwo Urologiczne
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Article published in Urologia Polska 1999/52/3.


Wiesław Wargocki 1, Tomasz Szydełko 2
1 Oddział Anestezjologii i Intensywnej Terapii Szpitala Wojewódzkiego we Wrocławiu
2 Katedra i Klinika Urologii AM we Wrocławiu


bladder bladder tumour obturator nerve unintended constrictions of abductors obturator nerve blockade


Introduction. Transurethral resection of bladder tumours bccomcs sometimes
difficult or cvcn impossible to carry out because of obluralor nerve excitation,
followed by intense unintended constrietions of thigh abductors. In that case
there is a danger of bladder perforation. Spinal or epidural anaesthesia applied
in TUR-B gives sufficient analgesic effect and sometimes muscles relaxation. In
spite of that muscles contraction may occur owing to the fact that currenls
from the resector excite obturator nerve bel low the site of blockade. Thus
depolarization spreads freely into muscles. Effcclivc Suppression of abductors
contraction is possible on the condition that the obturator nerve is blocked
below the site of excitation. The proper site of blockade is that, where nerve
leaves obturator canal. To make a blockade there is no need of changing the
patient operation position. He can lie with his legs raised. Moreover, in this
position the landmark, gracile muscle is more palpable. An isolated needle
connected to the stimulator should be inserted under the gracile muscle close
to the pubic symphisis. The needle is directed to the point 2 cm bellow the
upper arm of the pubic bone and 2-3 cm medially from the femoral artery.
When the most intense contractions of muscles appear 6 ml of bupivacaine
with epinephrine is administered.
Material and method. 17 patients who underwent TUR-B were cxamined.
Every one of them developed constrietions of thigh abductors during this
operation as a result of obturator nerve excitation. An intraoperativc ncrvc
blockade with a help of stimulator was performed. The efficacy of the method
depends on the range of abductors construction obtained during stimulation.
By means of a 4-degree scale, the dependence of efficacy of the method upon
these constrietions was evaluated.
Results. 14 patients did not develop any constrietions and 5 of them had
minutę constrietions what did not disturb the operation to be performed. 1
blockade failed to be successful because not sufficient muscle constrietions were
Conclusions. If proper muscle constrietions during simulation are obtained
the method turns out very effective. This enables a total resection of tumour.


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