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Avoiding the Obturator Jerk during TURBT.

Prasan I Panagoda1, Nikhil Vasdev2, Shan Gowrie-Mohan1

  • 1Department of Anesthesia, Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Lister Hospital, Stevenage, UK.

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Preventing obturator jerk during transurethral resection of bladder tumor (TURBT) surgery is crucial to avoid bladder perforation. Anesthesia and surgical techniques can minimize this risk, improving patient safety in bladder cancer treatment.

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Adductor spasmObturator jerkObturator reflexTransurethral resection of bladder tumor

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Area of Science:

  • Urology
  • Anesthesiology
  • Surgical Oncology

Background:

  • Bladder cancer is a significant health concern in the UK, ranking as the seventh most common cancer.
  • Transurethral resection of bladder tumor (TURBT) is a standard procedure for bladder tumor treatment.
  • Bladder perforation is a serious complication of TURBT, with obturator jerk increasing its risk.

Purpose of the Study:

  • To review and synthesize literature on techniques to mitigate obturator jerk during TURBT.
  • To identify surgical and anesthetic strategies for reducing adductor spasm in TURBT procedures.

Main Methods:

  • A comprehensive literature search was conducted on PubMed.
  • Search terms included "obturator nerve block," "obturator nerve block in transurethral resection of bladder tumor," "adductor spasm during transurethral resection of bladder tumor," "bi-polar diathermy obturator nerve," and "transvesical obturator nerve block."
  • Articles detailing methods to reduce adductor spasm during TURBT were included.

Main Results:

  • Surgical strategies to reduce obturator jerk involve lowering diathermy current and avoiding bladder over-distention.
  • The use of bipolar diathermy is suggested, though evidence is conflicting compared to monopolar diathermy.
  • Anesthetic interventions like neuromuscular blockade or obturator nerve blocks are recommended.

Conclusions:

  • Minimizing obturator jerk is essential to prevent serious complications like bladder perforation during TURBT.
  • Both surgical adjustments and anesthetic interventions play a role in enhancing patient safety.
  • Anesthetists should consider obturator nerve blocks or neuromuscular blockade to reduce obturator jerk incidence.