Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Transüretral Mesane Tümör Rezeksiyonlarında Obturator Blok Yapılmasının Cerrahi Başarı ve Cerrahi Memnuniyet Üzerine Etkisi: Randomize Kontrollü Çalışma
The Effect of Obturator Nerve Block on Surgical Success and Surgeons' Satisfaction in Transurethral Resection of Bladder Tumor: A Randomized Controlled Trial
Meltem BEKTAŞa, Türkay ÇAKANa, Servi YILDIRIMa, Yusuf Harun İRENa, Ali Kaan YILDIZb, Hülya BAŞARa, Koray AĞRASb
aSağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Ankara, Türkiye
bSağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Ankara, Türkiye
Turkiye Klinikleri J Anest Reanim. 2022;20(2):52-6
doi: 10.5336/anesthe.2022-87928
Article Language: TR
Full Text
ÖZET
 Amaç: Obturator sinirin mesane duvarına yakın seyretmesi nedeniyle, transüretral rezeksiyon sırasında sinirin elektriksel stimülasyonu perforasyon,kanama ve yetersiz tümör rezeksiyonu gibi ciddi komplikasyonlara neden olabilir.Çalışmamızda spinal anesteziye eklenen obturator sinir bloğunun addüktör kontraksiyonları önleme, cerrahi başarı ve cerrah memnuniyeti üzerine olan etkinliğinin araştırılması amaçlandı. Gereç ve Yöntemler: Etik kurul onayı ve hasta onamları alındıktan sonra, 115 hasta Grup 1 (spinal anestezi) ve Grup 2 (spinal anestezi ve obturator sinir bloğu) olacak şekilde 2 gruba randomize edildi. Obturator sinir bloğu uygulamaları, ultrasonografi eşliğinde inplane teknikle ve sinir stimülatörü kullanılarak yapıldı. Gruplar, addüktör kas kontraksiyonu varlığı ve şiddeti, cerrahi komplikasyon varlığı, doku örneklerinde kas dokusunun varlığı, ek anestezi ihtiyacı, cerrahi memnuniyet açısından istatistiksel olarak karşılaştırıldı. İstatistiksel analizde Pearson ki-kare ve Student t-testleri kullanıldı. Bulgular: Addüktör kas kontraksiyon şiddeti ve genel anestezi ihtiyacı Grup 2'de anlamlı olarak daha düşük bulundu. Grup 1'de genel anesteziye geçiş %27,1 iken Grup 2'de %10,7 idi. Cerrahi memnuniyet Grup 2'de anlamlı yüksek bulundu (Grup 2'de %82,1, Grup 1'de %61,4) (p0,005). Sonuç: Sonuç olarak, obturator sinir bloğu addüktör kas kontraksiyonlarını önler, genel anestezi ihtiyacını azaltır ve cerrah memnuniyetini artırır. Addüktör kas kontraksiyonları direk olarak cerrah memnuniyetini etkilediği için, obturator sinir bloğu transüretral mesane tümör rezeksiyonunda tercih edilebilecek anestezi yöntemi olabilir.

Anahtar Kelimeler: Transüretral rezeksiyon; mesane tümörü; obturator sinir bloğu; addüktör kontraksiyon; cerrahi memnuniyet
ABSTRACT
 Objective: Since, obturator nerve lies close to the wall of the bladder, electrical stimulation of the nerve during transurethral resection can provoke adductor muscle contractions which can lead to serious complications like perforation, bleeding or incomplete resection of the tumor. We aimed to investigate the efficacy of obturator nerve block added to spinal anesthesia to prevent adductor contractions, on surgical success and surgeon satisfaction. Material and Methods: After approval of institutional ethics committee and patient consents, 115 patients were randomly divided into 2 groups as Group 1 (spinal anesthesia) and Group 2 (spinal anesthesia and obturator nerve block). Obturator nerve block was performed by both ultrasonography using in-plane technique and nerve stimulator. Presence and severity of adductor muscle contractions, surgical complications, presence of muscle tissur in specimens, requirement of additional anesthesia, surgeons' satisfaction were compared between groups. Pearson chi-square test and Student t-test were used for statistical analysis. Results: Adductor muscle contraction and requirement for general anesthesia was significantly lower in Group 2. General anesthesia was required in 27.1% and 10.7 % of patients in Group 1 and Group 2, respectively. Surgeons' satisfaction was significantly higher in Group 2 than in Group 1 (82.1% in Group 2, 61.4% in Group 1) (p0.005). Conclusion: As a result, obturator nerve block prevents adductor muscle contractions, reduces requirement for general anesthesia and increases surgeons' satisfaction. Obturator nerve block could be a preferred anesthetic technique for transurethral bladder tumor resection as the adductor muscle contractions directly affect surgeons' satisfaction.

Keywords: Transurethral resection; bladder tumor; obturator nerve block; adductor contraction; surgeons' satisfaction
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