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
BAUS ePoster online library. Krishan A. 06/22/21; 319013; p10-5
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Mr. Anil Krishan
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Abstract
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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 (AGPs). 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 studies. Random effects modelling was used to calculate pooled outcome data.
Results
Four randomised control trials (RCTs) and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB 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 SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as general anaesthesia is paramount, the use of SA+ONB 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.
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 (AGPs). 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 studies. Random effects modelling was used to calculate pooled outcome data.
Results
Four randomised control trials (RCTs) and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB 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 SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as general anaesthesia is paramount, the use of SA+ONB 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.
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 (AGPs). 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 studies. Random effects modelling was used to calculate pooled outcome data.
Results
Four randomised control trials (RCTs) and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB 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 SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as general anaesthesia is paramount, the use of SA+ONB 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.
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 (AGPs). 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 studies. Random effects modelling was used to calculate pooled outcome data.
Results
Four randomised control trials (RCTs) and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB 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 SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as general anaesthesia is paramount, the use of SA+ONB 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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