MP16-09 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
Bibliographic record
Abstract
You have accessJournal of UrologyBladder Cancer: Non-invasive II (MP16)1 Sep 2021MP16-09 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 Krishan, Angus Bruce, Shehab Khashaba, Mohamed Abouelela, and Syed Ali Ehsanullah Anil KrishanAnil Krishan More articles by this author , Angus BruceAngus Bruce More articles by this author , Shehab KhashabaShehab Khashaba More articles by this author , Mohamed AbouelelaMohamed Abouelela More articles by this author , and Syed Ali EhsanullahSyed Ali Ehsanullah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002001.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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 (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar and Web of Science), identifying studies comparing the outcomes of TURBT using spinal anaesthesia versus spinal with an obturator nerve block. 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: Searches of electronic databases resulted in 107 articles, from which four randomised control trials (RCTs) and three cohort studies met the eligibility criteria, enrolling a total of 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. Source of Funding: Nil © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e299-e300 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anil Krishan More articles by this author Angus Bruce More articles by this author Shehab Khashaba More articles by this author Mohamed Abouelela More articles by this author Syed Ali Ehsanullah More articles by this author Expand All Advertisement Loading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.023 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".