Comparison of bladder tumour resection under nerve stimulator guided obturator nerve block versus neuromuscular blockade

Transurethral resection of bladder tumor TURBT is a common procedure for diagnosis and treatment of bladder cancer. Tumors located on the lateral and posterolateral bladder wall often cause intraoperative obturator nerve stimulation leading to sudden thigh adduction known as obturator jerk. This can result in bladder perforation, incomplete resection, and increased morbidity. Two main strategies are used to prevent this complication. One is obturator nerve block ONB performed with regional anesthesia and the other is general anesthesia with neuromuscular blockade GA NMB. While GA NMB reliably abolishes obturator reflex, it carries risks in elderly patients with comorbidities. ONB is safer in such patients but technically demanding. Evidence comparing surgeon performed nerve stimulator guided ONB with GA NMB in the Indian setting is limited.

This prospective randomized controlled trial will compare the effectiveness of ONB with regional anesthesia versus GA with NMB in patients undergoing TURBT for lateral and posterolateral bladder wall tumors. The primary outcome is incidence of obturator jerk. Secondary outcomes include completeness of resection, presence of detrusor muscle in specimen, bladder perforation, operative time, anesthesia time, complications, hospital stay, and need for reintervention. Ninety patients will be randomized equally into two groups. Results will help determine whether surgeon performed ONB is non inferior to GA NMB in preventing obturator jerk and improving surgical outcomes in routine practice