Comparison of Obturator Nerve Blockade and Neuromuscular Blockade
Condition: Cancer of Bladder
MeSH terms: Urinary Bladder Neoplasms
Intervention: Obturator block; Neuromuscular block
Intervention description: 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.
Intervention MeSH terms: Anesthetics; Mepivacaine; Rocuronium
Phase: Phase 4
Study type: Interventional
Primary purpose: Basic Science
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)
Enrollment: 60.0
Sex: All
Minimum age: 18 Years
Maximum age: 90 Years
Healthy volunteers: No

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.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients ≥ 18 years of age

          -  Planned TURBT for unilateral or bilateral posterolateral bladder tumors

          -  Ability to understand and provide informed consent

        Exclusion Criteria:

          -  Patient refusal or inability to provide informed consent

          -  True allergy, not sensitivity, to local anesthetics

          -  True allergy, not sensitivity, Propofol

          -  True allergy, not sensitivity, general anesthetic agents

          -  Pregnancy

          -  Severe hepatic impairment

          -  Evidence of infection at or near the proposed needle insertion site

          -  Any sensorimotor deficit of the lower extremity, whether acute or chronic

          -  Inability to walk without assistance

          -  Lower extremity joint replacement surgery in the preceding six months