Objective To evaluate the clinical efficacy and safety of the inguinal approach versus classical pubic approach for obturator nerve block (ONB) in transurethral resection of bladder tumors (TUR-BT).Methods Databases including PubMed, The Cochrane Library, EMbase, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to identify randomized controlled trials using ONB in TUR-BT from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using Stata 14.2 software.Results A total of 7 studies involving 474 patients were included. The meta-analysis results showed that there was no significant difference between inguinal approach and pubic approach in terms of the ONB success rate (RR=1.06, 95%CI 0.96 to 1.17, P=0.23), while the one-time success rate of puncture of inguinal approach was higher than that of pubic approach (RR=1.47, 95%CI 1.01 to 2.15, P=0.04). Compared with the pubic approach, the overall complications of inguinal approach were lower (RR=0.24, 95%CI 0.08 to 0.71, P=0.01). However, no significant difference was found between the two groups in terms of subcutaneous hematoma (RR=0.46, 95%CI 0.08 to 2.66, P=0.38).Conclusions The current evidence indicates that the success rate of one puncture of inguinal approach is higher than that of pubic approach, and the overall complications of the inguinal approach are much lower than that of the pubic approach. However, the above conclusions are still required to be verified through more high-quality studies due to the limited quantity and quality of included studies.
QIU Chao, FENG Dechao, LIU Shengzhuo, YANG Yubo, BAI Yunjin, HAN Ping, WEI Wuran. Comparison of inguinal approach versus classical pubic approach for obturator nerve block in transurethral resection of bladder tumors: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(5): 573-577. doi: 10.7507/1672-2531.202005130