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
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