Abstract / Summary
ABSTRACT Background: The obturator nerve block (ONB) is commonly used during transurethral resection of bladder tumor (TURBT) to prevent adductor spasm. Both ultrasound (US)-guided and nerve stimulation (NS) techniques are available, but whether adding NS to US improves block outcomes remains debated. Methods: We searched PubMed, Cochrane Library, and Web of Science up to 6 April 2026. The rate of adductor spasm prevention, block performance time, onset time, number of needle passes, patient and surgeon satisfaction, and complications were evaluated. Pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated. Results: Five randomized controlled trials (RCTs) comprising 451 patients were analyzed. The US + NS group significantly improved block rate of adductor spasm prevention compared to US alone (OR = 3.20, 95% CI: 1.72–5.93, P < 0.001; I ² =0%), but required longer performance time (MD = 1.99 min, 95% CI: 1.51–2.47, P < 0.001; I ² =91%). No differences were found in needle passes or onset time. Complications were rare and comparable. Conclusions: Combining nerve stimulation with US guidance for ONB significantly improves rate of adductor spasm prevention and patient/surgeon satisfaction compared to US guidance alone, although with a longer block performance time. The two techniques are similar in onset time and needle passes. US + NS is recommended for ONB during TURBT.