Comparison of inguinal approach versus classical pubic approach for obturator nerve block in transurethral resection of bladder tumors: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

QIU Chao ^1,2 , FENG Dechao ¹ , LIU Shengzhuo ¹ , YANG Yubo ¹ , BAI Yunjin ¹ , HAN Ping ¹ ,  WEI Wuran ¹

1. Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Urology, Enyang District People’s Hospital, Bazhong 636063, P.R.China;

Corresponding author：

WEI Wuran, Email: weiwuran@126.com

Keywords：

Obturator nerve block; Transurethral resection of bladder tumors; Neuraxial anesthesia; Inguinal approach; Pubic approach; Meta-analysis; Randomized coutrolled trial

DOI：

10.7507/1672-2531.202005130

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Objective To evaluate the clinical efficacy and safety of the inguinal approach versus classical pubic approach for obturator nerve block (ONB) in transurethral resection of bladder tumors (TUR-BT).Methods Databases including PubMed, The Cochrane Library, EMbase, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to identify randomized controlled trials using ONB in TUR-BT from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using Stata 14.2 software.Results A total of 7 studies involving 474 patients were included. The meta-analysis results showed that there was no significant difference between inguinal approach and pubic approach in terms of the ONB success rate (RR=1.06, 95%CI 0.96 to 1.17, P=0.23), while the one-time success rate of puncture of inguinal approach was higher than that of pubic approach (RR=1.47, 95%CI 1.01 to 2.15, P=0.04). Compared with the pubic approach, the overall complications of inguinal approach were lower (RR=0.24, 95%CI 0.08 to 0.71, P=0.01). However, no significant difference was found between the two groups in terms of subcutaneous hematoma (RR=0.46, 95%CI 0.08 to 2.66, P=0.38).Conclusions The current evidence indicates that the success rate of one puncture of inguinal approach is higher than that of pubic approach, and the overall complications of the inguinal approach are much lower than that of the pubic approach. However, the above conclusions are still required to be verified through more high-quality studies due to the limited quantity and quality of included studies.

Citation： QIU Chao, FENG Dechao, LIU Shengzhuo, YANG Yubo, BAI Yunjin, HAN Ping, WEI Wuran. Comparison of inguinal approach versus classical pubic approach for obturator nerve block in transurethral resection of bladder tumors: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(5): 573-577. doi: 10.7507/1672-2531.202005130 Copy

1.	王璇, 游志坚, 吴佳璇. 超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中预防闭孔神经反射的效果. 临床麻醉学杂志, 2017, 33(12): 1189-1191.
2.	卢悦淳, 高春霖, 吕国义, 等. 腹股沟和耻骨入路闭孔神经阻滞用于预防经尿道膀胱肿瘤电切术病人闭孔神经反射效果的比较. 中华麻醉学杂志, 2012, 32(3): 379-380.
3.	李颖波, 余开峰, 冉然. 闭孔神经与膀胱肿瘤基底部联合阻滞在经尿道膀胱肿瘤电切术中的应用. 湖北医药学院学报, 2012, 31(1): 32-34.
4.	Erbay G, Akyol F, Karabakan M, et al. Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease. Kaohsiung J Med Sci, 2017, 33(2): 86-90.
5.	Ong EL, Chan ST. Transurethral surgery and the adductor spasm. Ann Acad Med Singap, 2000, 29(2): 259-262.
6.	Hızlı F, Argun G, Güney I, et al. Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial. Ir J Med Sci, 2016, 185(3): 555-560.
7.	Khorrami M, Hadi M, Javid A, et al. A comparison between blind and nerve stimulation guided obturator nerve block in transurethral resection of bladder tumor. J Endourol, 2012, 26(10): 1319-1322.
8.	Prentiss RJ, Harvey GW, Bethard WF, et al. Massive adductor muscle contraction in transurethral surgery, cause and prevention; in development of new electrical circuitry. J Urol, 1965, 93: 263-271.
9.	Bolat D, Aydogdu O, Tekgul ZT, et al. Impact of nerve stimulator-guided obturator nerve block on the short-term outcomes and complications of transurethral resection of bladder tumour: A prospective randomized controlled study. Can Urol Assoc J, 2015, 9(11-12): E780-784.
10.	Tekgül ZT, Divrik RT, Turan M, et al. Impact of obturator nerve block on the short-term recurrence of superficial bladder tumors on the lateral wall. Urol J, 2014, 11(1): 1248-1252.
11.	Choquet O, Capdevila X, Bennourine K, et al. A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies. Anesthesiology, 2005, 103(6): 1238-1245.
12.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 2009, 6: e1000097.
13.	马捷, 刘莹, 钟来平, 等. Jadad量表与Cochrane偏倚风险评估工具在随机对照试验质量评价中的应用与比较. 中国口腔颌面外科杂志, 2012, 10(5): 417-422.
14.	张本福. 新径路闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用. 临床麻醉学杂志, 2011, 27(4): 388-389.
15.	王小北, 崔永康, 田兵, 等. 腹股沟入路闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用. 中国保健营养, 2015, 25(9): 45-46.
16.	胡颖. 改良法闭孔神经阻滞在膀胱肿瘤电切术中的临床应用. 重庆医学, 2013, (22): 2691-2691, 2692.
17.	Dagli R, Dadali M, Emir L, et al. Comparison of classic and inguinal obturator nerve blocks applied for preventing adductor muscle contractions in bladder tumor surgeries: a prospective randomized trial. Urol J, 2019, 16: 62-66.
18.	Aghamohammadi D, Gargari RM, Fakhari S, et al. Classic versus inguinal approach for obturator nerve block in transurethral resection of bladder cancer under spinal anesthesia: a randomized controlled trial. Iran J Med Sci, 2018, 43(1): 75-80.
19.	Jo YY, Choi E, Kil HK. Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB. Korean J Anesthesiol, 2011, 61(2): 143-147.
20.	Moningi S, Durga P, Ramachandran G, et al. Comparison of inguinal versus classic approach for obturator nerve block in patients undergoing transurethral resection of bladder tumors under spinal anesthesia. J Anaesthesiol Clin Pharmacol, 2014, 30(1): 41-45.
21.	Heywang-Köbrunner SH, Amaya B, Okoniewski M, et al. CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip. Eur Radiol, 2001, 11(6): 1047-1053.
22.	Soong J, Schafhalter-Zoppoth I, Gray AT. Sonographic imaging of the obturator nerve for regional block. Reg Anesth Pain Med, 2007, 32(2): 146-151.
23.	Akkaya T, Ozturk E, Comert A, et al. Ultrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach. Anesth Analg, 2009, 108(3): 1037-1041.
24.	Viel EJ, Perennou D, Ripart J, et al. Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles. Eur J Pain, 2002, 6(2): 97-104.
25.	Taboada M, Rodríguez J, ALvarez J, et al. Sciatic nerve block via posterior Labat approach is more efficient than lateral popliteal approach using a double-injection technique: a prospective, randomized comparison. Anesthesiology, 2004, 101(1): 138-142.
26.	Macalou D, Trueck S, Meuret P, et al. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg, 2004, 99(1): 251-254.
27.	Kakinohana M, Taira Y, Saitoh T, et al. Interadductor approach to obturator nerve block for transurethral resection procedure: comparison with traditional approach. J Anesth, 2002, 16(2): 123-126.

1. 王璇, 游志坚, 吴佳璇. 超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中预防闭孔神经反射的效果. 临床麻醉学杂志, 2017, 33(12): 1189-1191.
2. 卢悦淳, 高春霖, 吕国义, 等. 腹股沟和耻骨入路闭孔神经阻滞用于预防经尿道膀胱肿瘤电切术病人闭孔神经反射效果的比较. 中华麻醉学杂志, 2012, 32(3): 379-380.
3. 李颖波, 余开峰, 冉然. 闭孔神经与膀胱肿瘤基底部联合阻滞在经尿道膀胱肿瘤电切术中的应用. 湖北医药学院学报, 2012, 31(1): 32-34.
4. Erbay G, Akyol F, Karabakan M, et al. Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease. Kaohsiung J Med Sci, 2017, 33(2): 86-90.
5. Ong EL, Chan ST. Transurethral surgery and the adductor spasm. Ann Acad Med Singap, 2000, 29(2): 259-262.
6. Hızlı F, Argun G, Güney I, et al. Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial. Ir J Med Sci, 2016, 185(3): 555-560.
7. Khorrami M, Hadi M, Javid A, et al. A comparison between blind and nerve stimulation guided obturator nerve block in transurethral resection of bladder tumor. J Endourol, 2012, 26(10): 1319-1322.
8. Prentiss RJ, Harvey GW, Bethard WF, et al. Massive adductor muscle contraction in transurethral surgery, cause and prevention; in development of new electrical circuitry. J Urol, 1965, 93: 263-271.
9. Bolat D, Aydogdu O, Tekgul ZT, et al. Impact of nerve stimulator-guided obturator nerve block on the short-term outcomes and complications of transurethral resection of bladder tumour: A prospective randomized controlled study. Can Urol Assoc J, 2015, 9(11-12): E780-784.
10. Tekgül ZT, Divrik RT, Turan M, et al. Impact of obturator nerve block on the short-term recurrence of superficial bladder tumors on the lateral wall. Urol J, 2014, 11(1): 1248-1252.
11. Choquet O, Capdevila X, Bennourine K, et al. A new inguinal approach for the obturator nerve block: anatomical and randomized clinical studies. Anesthesiology, 2005, 103(6): 1238-1245.
12. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 2009, 6: e1000097.
13. 马捷, 刘莹, 钟来平, 等. Jadad量表与Cochrane偏倚风险评估工具在随机对照试验质量评价中的应用与比较. 中国口腔颌面外科杂志, 2012, 10(5): 417-422.
14. 张本福. 新径路闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用. 临床麻醉学杂志, 2011, 27(4): 388-389.
15. 王小北, 崔永康, 田兵, 等. 腹股沟入路闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用. 中国保健营养, 2015, 25(9): 45-46.
16. 胡颖. 改良法闭孔神经阻滞在膀胱肿瘤电切术中的临床应用. 重庆医学, 2013, (22): 2691-2691, 2692.
17. Dagli R, Dadali M, Emir L, et al. Comparison of classic and inguinal obturator nerve blocks applied for preventing adductor muscle contractions in bladder tumor surgeries: a prospective randomized trial. Urol J, 2019, 16: 62-66.
18. Aghamohammadi D, Gargari RM, Fakhari S, et al. Classic versus inguinal approach for obturator nerve block in transurethral resection of bladder cancer under spinal anesthesia: a randomized controlled trial. Iran J Med Sci, 2018, 43(1): 75-80.
19. Jo YY, Choi E, Kil HK. Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB. Korean J Anesthesiol, 2011, 61(2): 143-147.
20. Moningi S, Durga P, Ramachandran G, et al. Comparison of inguinal versus classic approach for obturator nerve block in patients undergoing transurethral resection of bladder tumors under spinal anesthesia. J Anaesthesiol Clin Pharmacol, 2014, 30(1): 41-45.
21. Heywang-Köbrunner SH, Amaya B, Okoniewski M, et al. CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip. Eur Radiol, 2001, 11(6): 1047-1053.
22. Soong J, Schafhalter-Zoppoth I, Gray AT. Sonographic imaging of the obturator nerve for regional block. Reg Anesth Pain Med, 2007, 32(2): 146-151.
23. Akkaya T, Ozturk E, Comert A, et al. Ultrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach. Anesth Analg, 2009, 108(3): 1037-1041.
24. Viel EJ, Perennou D, Ripart J, et al. Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles. Eur J Pain, 2002, 6(2): 97-104.
25. Taboada M, Rodríguez J, ALvarez J, et al. Sciatic nerve block via posterior Labat approach is more efficient than lateral popliteal approach using a double-injection technique: a prospective, randomized comparison. Anesthesiology, 2004, 101(1): 138-142.
26. Macalou D, Trueck S, Meuret P, et al. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg, 2004, 99(1): 251-254.
27. Kakinohana M, Taira Y, Saitoh T, et al. Interadductor approach to obturator nerve block for transurethral resection procedure: comparison with traditional approach. J Anesth, 2002, 16(2): 123-126.

Chinese Journal of Evidence-Based Medicine

Comparison of inguinal approach versus classical pubic approach for obturator nerve block in transurethral resection of bladder tumors: a meta-analysis

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