UNINTENDED CONSTRICTIONS OF THIGH ABDUCTORS DURIG TRANSURETHRAL RESECTION OF BLADDER TUMOURS
Article published in Urologia Polska 1999/52/3.

authors

Wiesław Wargocki ¹, Tomasz Szydełko ²

¹ Oddział Anestezjologii i Intensywnej Terapii Szpitala Wojewódzkiego we Wrocławiu
² Katedra i Klinika Urologii AM we Wrocławiu

keywords

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

summary

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

obtained.

Conclusions. If proper muscle constrietions during simulation are obtained

the method turns out very effective. This enables a total resection of tumour.

references