Comparing lidocaine versus mepivacaine in obturator nerve block for transurethral resection of the bladder

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INTRODUCTION

During transurethral resection of the bladder (TURB) adductor muscle contraction can occur due to obturator nerve stimulation. Obturator nerve blockade (ONB) is a accepted method to decrease the risk of obturator nerve reflex (ONR) during TURB. Insufficient ONB and subsequent leg jerking lead to bladder perforation, increased bleeding and early tumor relapse. The use of a sufficient local anesthetic (LA) and an ultrasound (US)-based ONB technique lower the risk of an ONB failure. In this study we report the effect of two types of LA (lidocaine vs. mepivacaine) on the success rate of ONB as well as of other parameters.

METHODS

In a non randomized, non blinded prospective trial the occurance of ONR was investigated in dependence of the LA. Patients in period 1 were treated with lidocaine, patients in period 2 with mepivacaine during TURB in a single institution. Further paramaters such as ONB techniques with or without US-guidance, TURB techniques (monopolar vs. bipolar), training level of surgeons and anesthesiologists and others were measured. Training level was grouped in medical doctors in training (residents) and specialists. Any kind of ONR was recorded as ONB failure. Pearson chi square test or t-test or Mann Whitney U test were used for statistical analyses with a p-value