TURBT
Conditions
Keywords
Pericapsular Nerve Group (PENG) block, obturator nerve reflex
Brief summary
This study aims to determine the efficacy and safety of the Pericapsular Nerve Group (PENG) block in preventing obturator nerve reflex during transurethral resection of bladder tumors.
Detailed description
During transurethral resection of bladder tumors (TURBT), obturator nerve reflex is easily triggered during electrocautery. Currently, two primary methods are used to prevent obturator nerve reflex: deep neuromuscular blockade under general anesthesia and obturator nerve block. To date, no studies have confirmed the efficacy of the Pericapsular Nerve Group (PENG) block in preventing obturator nerve reflex. This study recorded the percentage decrease in adductor muscle strength at various time points after the PENG block, the occurrence of intraoperative adductor muscle spasms, the duration of nerve block procedure, and the incidence of postoperative adverse events. The completion of this study could provide clinical evidence for selecting anesthesia methods in TURBT procedures and offer robust evidence-based support for relevant medical decisions by government health agencies.
Interventions
PROCEDUREpeng block
A convex ultrasound probe (frequency 2-5 MHz) was positioned at the patient's inguinal ligament, with one end directed toward the anterior inferior iliac spine (AIIS), clearly visualizing the bony prominences of the iliopubic eminence and the AIIS. The needle tip was directed medially toward the pectineus muscle. Upon reaching the space between the pectineus muscle and the pubic bone, and after confirming the absence of blood on aspiration, 30 ml of 0.375% ropivacaine was injected.
PROCEDUREobturator nerve block
An ultrasound probe was positioned at the inguinal ligament, with the needle inserted parallel to the long axis of the probe. After confirming no blood upon aspiration, 15 ml of 0.375% ropivacaine was injected into the fascial plane between the adductor brevis and adductor magnus, as well as into the midportion of the adductor longus and adductor brevis muscles.
Sponsors
Nanjing First Hospital, Nanjing Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 79 Years
Healthy volunteers
Yes
Inclusion criteria
* Aged 18 years or older; * Scheduled for TURBT for unilateral bladder tumor; * Able to understand and provide informed consent;
Exclusion criteria
* Patients who refuse or are unable to provide informed consent; * Allergic to local anesthetics, insensitive to propofol or general anesthetics; * Pregnant women; * Severe liver dysfunction; * Evidence of infection at or near the proposed puncture site; * Any sensory or motor impairment of the lower limbs; * Recent (within 6 months) lower limb joint replacement surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the percentage reduction in adductor muscle strength at 5, 10, 15, 20, 25, 30 minutes, and 3 hours after drug administration, compared to pre-administration levels. | 5, 10, 15, 20, 25, 30 minutes, and 3 hours post-administration | The percentage increase in adductor strength from preoperative to postoperative measurements divided by preoperative adductor strength is larger, reflecting a better nerve block effect and superior obturator nerve reflex inhibition. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Presence of obturator nerve reflex during surgery | During surgery | Obturator nerve reflex grading system: No response in the adductor muscle group of the thigh; mild muscle twitching in the adductor muscle group of the thigh; severe contraction of the adductor muscle group of the thigh |
Other
| Measure | Time frame | Description |
|---|---|---|
| Surgical Duration | During surgery | Indirectly reflects interference from obturator nerve reflex; shorter duration implies effective reflex suppression |
| Needle Pass Count | During nerve block procedures | Fewer passes indicate simpler operation and higher precision. |
| Physician Satisfaction Score | Up to 48 hours postoperative | Grading: Excellent (1 point) Good (2 points) Fair (3 points) Poor (4 points) Higher scores indicate superior inhibition of obturator nerve reflex and better block efficacy |
| Patient Satisfaction Score Patient Satisfaction Score Patient Satisfaction Score | Up to 48 hours postoperative | Grading: Excellent (1 point) Good (2 points) Fair (3 points) Poor (4 points) Higher scores reflect enhanced patient comfort during the procedure |
| Operational Duration of Nerve Block | During nerve block procedures | Reflects procedural convenience; shorter duration indicates simpler technique |
| Incidence of adverse reactions such as local anesthetic toxicity and nerve injury post-administration. | Up to 48 hours postoperative | The lower the incidence of adverse reactions such as local anesthetic toxicity and nerve injury, the better the PENG block technique. quantifies safety profile (lower incidence indicates higher safety) |
Countries
China
Outcome results
None listed