Comparison of Obturator Nerve Blockade and Neuromuscular Blockade
Condition: Cancer of Bladder
MeSH terms: Urinary Bladder Neoplasms
Study type: Interventional
Phase: Phase 4

Summary: 
      Patients diagnosed with posterolateral bladder tumors will be invited to participate in the
      study. Subjects will be randomized to receive an ultrasound-guided obturator block or a
      neuromuscular blocking agent after the induction of general anesthesia in an attempt to block
      the obturator reflex during surgery.
    

Detailed description: 
      The purpose of this research is to compare the incidence of adductor spasm in patients
      undergoing general anesthesia with neuromuscular blocking agents versus obturator block.
      Transurethral resection of bladder tumor(s) (TURBT) is a commonly performed procedure to
      diagnose and treat bladder cancer. The obturator nerve is located lateral to the bladder wall
      in the pelvis prior to innervating the adductor muscles of the thigh. Depending on the
      location of the tumor(s), electrocautery or surgical stimulation may result in stimulation of
      the obturator nerve, resulting in adduction of the leg, which is called the adductor reflex
      or spasm. This may occur violently and unexpectedly, and result in bladder perforation,
      bleeding, or cancer dissemination.
    

Intervention name(s): Obturator block; Neuromuscular block
Intervention type(s): Drug; Drug
Intervention description(s): Subjects allocated to the obturator block group will be monitored for the incidence of block and procedure-related adverse events. In addition to clinical observation, a Nerve Integrity Monitor (Medtronic) will be used to detect adductor spasm using continuous electromyography. Electrodes will be placed on the thigh to objectively detect and record instances of adductor spasm. One hour after arrival to post-anaesthesia care unit (PACU) or when discharge criteria are met (whichever comes first), repeat dynamometer measurements and TUG tests will be performed. Patients will be called 24-48 hours post procedure to inquire about falls or evidence of nerve injury, as well as patient satisfaction.; Subjects allocated to the neuromuscular block group will be monitored for the incidence of block and procedure-related adverse events. In addition to clinical observation, a Nerve Integrity Monitor (Medtronic) will be used to detect adductor spasm using continuous electromyography. Electrodes will be placed on the thigh to objectively detect and record instances of adductor spasm. One hour after arrival to PACU or when discharge criteria are met (whichever comes first), repeat dynamometer measurements and TUG tests will be performed. Patients will be called 24-48 hours post procedure to inquire about falls or evidence of nerve injury, as well as patient satisfaction.
Other intervention name(s): Ultrasound guided nerve block anesthetic; Mepivacaine; Pajunk SonoPlex needle; Paralysis of the affected skeletal muscles anesthetic; Rocuronium
Intervention MeSH terms: Anesthetics; Mepivacaine; Rocuronium
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Sixty subjects with be randomized to the obturator block or neuromuscular block arm upon enrollment, using randomized permutated blocks of six.
Masking: None (Open Label)
Primary purpose: Basic Science