UP-29 Safety and efficacy of transurethral resection of bladder tumour comparing spinal anaesthesia to spinal anaesthesia with an obturator nerve block: a systematic review and meta-analysis
Thursday June 27, 2019 from
TBD
Presenter

Anil Krishan, United Kingdom

Core Surgical Trainee

Urology

Walsall Manor Hospital

Abstract

Safety and efficacy of transurethral resection of bladder tumour comparing spinal anaesthesia to spinal anaesthesia with an obturator nerve block: A systematic review and meta-analysis

Anil Krishan1, Angus Bruce1, Shehab Khashaba2, Mohamed Abouelela3, Syed A Ehsanullah4.

1Urology, Walsall Manor Hospital, Walsall, United Kingdom; 2Urology, King Hamad University Hospital, Busaiteen, Bahrain; 3Anaesthesia, King Hamad University Hospital, Busaiteen, Bahrain; 4Urology, University Hospitals Birmingham, Birmingham, United Kingdom

Introduction: To investigate whether spinal anaesthesia with an obturator nerve block (SA+ONB) can be effectively employed for transurethral resection of bladder tumours (TURBT) during the COVID-19 pandemic to improve patient outcomes whilst also avoiding aerosol-generating procedures. We aimed to compare outcomes of TURBT using spinal anaesthesia (SA) alone versus SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumour resection, tumour recurrence and local anaesthetic toxicity.

Methods: We conducted a comprehensive search of electronic databases, identifying studies comparing the outcomes of TURBT using SA versus SA+ONB. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data.

Results: Four randomised control trials (RCTs) and 3 cohort studies were identified, enrolling 448 patients. The use of spinal anaesthesia with an obturator nerve block was associated with a significantly reduced risk of obturator reflex (P<0.00001), bladder perforation (P=0.02), incomplete resection (P<0.0001) and 12-month tumour recurrence (P=0.005). Obturator nerve block was not associated with an increased risk of local anaesthetic toxicity (0/159).

Conclusions: Our meta-analysis suggests that TURBT employing spinal anaesthesia with an obturator nerve block is superior to the use of spinal anaesthesia alone. During the COVID-19 pandemic, where avoidance of aerosol-generating procedures (AGPs) such as a general anaesthesia is paramount, the use of an obturator nerve block with spinal anaesthesia is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of obturator nerve block as well as comparing this method to general anaesthesia with complete neuromuscular blockade.


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