Gamze ERTAŞ, Hamiyet ŞENOL ÇAKMAK, Alparslan Can DEMİRCİ, Reha ORDULU, Serkan TULGAR, Mustafa SÜREN
Journal of Health Sciences and Medicine - 2026;9(3):591-595
Aims: Obturator reflex during transurethral resection of bladder tumors (TUR-M), particularly in lateral wall lesions, may cause serious intraoperative complications. This study aimed to evaluate the clinical effectiveness and safety of ultrasound-guided obturator nerve block (ONB) in preventing obturator reflex during TUR-M. Methods: This single-center retrospective observational study included adult patients who underwent TUR-M with ultrasound-guided ONB between January 2022 and September 2025. Demographic data, anesthetic techniques, ONB characteristics, intraoperative obturator reflex occurrence, and block-related complications were obtained from anesthesia and surgical records. ONB was performed using a standardized ultrasound-guided distal two-branch technique with additional nerve stimulation for functional confirmation. Block success was defined as the absence of clinically significant obturator reflex during surgery. Results: A total of 989 TUR-M procedures were performed during the study period, and ultrasound-guided ONB was applied in 143 patients. After exclusion of patients with incomplete or inconsistent data, 137 patients were included in the analysis. Obturator reflex occurred in 9 patients (6.5%), resulting in an overall block success rate of 93.4%. All surgical procedures were completed successfully despite reflex occurrence. No block-related or local anesthetic-related complications were observed. Obturator reflex was observed only in patients who received unilateral ONB, while no reflex occurred in bilateral applications. There was no statistically significant difference in block success between unilateral and bilateral ONB (p=0.61). Conclusion: Ultrasound-guided ONB, performed using a standardized distal two-branch technique with nerve stimulation confirmation, is a safe and highly effective adjunctive method for preventing obturator reflex during TUR-M. This approach may enhance surgical safety and operative comfort, particularly in patients with laterally located bladder tumors.
