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Background and Aims Transurethral resection of bladder tumor (TUR-BT) is the gold standard for the diagnosis and initial treatment of this type of cancer. Bladder perforation is a major complication associated with both surgery and anesthesia. Obturator nerve (ON) block minimizing the risk of ON reflex (ONR) has been proposed as an effective strategy to prevent this catastrophic complication.

Methods An 85 year -old male, ASA III, patient, presented in our Anesthesiology Department for TUR-BT. Preoperative bladder ultrasound revealed a tumor affecting both lateral walls. After explaining the procedure to the patient and having obtained informed consent, the high frequency ultrasound probe was placed, under sterile conditions, at the medial aspect of the right femoral crease and a 50 mm- long insulated needle was inserted in plane and guided in the fascial plane between the pectineus and adductor brevis and the fascial plane between adductor brevis and adductor magnus muscles. Local anesthetic solution was incrementally injected (15 ml mixture ropivacaine 0,5% with lignocaine 0,1%). The same procedure was repeated to block the branches of the left ON. Twenty minutes after bilateral block, 3 ml hyperbaric bupivacaine 0,5% and 10mcg fentanyl were injected intrathecally.

Results During the 50 -minute procedure no obturator jerk was observed and no other adverse effect was recorded.

Conclusions Spinal anesthesia (SA) combined with ONB has been shown to be superior to SA alone, in reducing the incidence of adductor spasm and associated complications. Our case provides additional evidence encouraging the application of ONB in patients presenting for TUR-BT.