{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:09:53Z","timestamp":1790892593868,"version":"4.1.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Adductor muscle spasm occurs when the obturator nerve is directly stimulated by the electrical current transmitted by the resectoscope. Ultrasound-guided ONB is regarded as the optimal technique and is classified as the proximal and distal approach based on the anatomical location of the obturator nerve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>\n                      This study included 90 adult patients of ASA grades I\u2013III and aged more than 18 years undergoing transurethral resection of bladder tumors under spinal anesthesia. Patients were randomized into two groups: group P received ultrasound-guided obturator nerve block (ONB) by proximal approach, and group D received ultrasound-guided ONB by distal approach. Adductor muscle power after the block, block performance time, complications, and adductor jerks during surgery were compared. A\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value of &lt; 0.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Adductor jerks during the surgery were absent in 85.7% of patients in group P and 78.0% of patients in group D. The mean block performance time in group P was 4.33 \u00b1 0.38 minutes, and in group D was 4.00 \u00b1 0.34 minutes. Vascular puncture during the block was observed in nine patients in group P and two patients in group D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The success rate in terms of the absence of adductor spasm during surgery was higher in proximal than in distal ultrasound-guided ONB. However, the proximal technique requires more time to perform the block than the distal technique, as it is technically challenging and carries a risk of vascular puncture.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_99_25","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T13:00:29Z","timestamp":1766754029000},"page":"88-93","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of proximal versus distal approach for ultrasound-guided obturator nerve block for prevention of adductor spasm in patients undergoing transurethral resection of urinary bladder tumors"],"prefix":"10.4103","volume":"42","author":[{"given":"Vinod","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, 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Res"},{"key":"R12-20251226","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/00000542-200602000-00024","article-title":"Ultrasound-guided regional anesthesia: Current state of the art","volume":"104","author":"Gray","year":"2006","journal-title":"Anesthesiology"},{"key":"R13-20251226","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.2147\/CMAR.S191540","article-title":"Effect of ultrasound-guided proximal and distal approach for obturator nerve block in transurethral resection of bladder cancer under spinal anesthesia","volume":"11","author":"Han","year":"2019","journal-title":"Cancer Manag Res"},{"key":"R14-20251226","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/AAP.0b013e3181a32c4d","article-title":"Ultrasound-guided obturator nerve block an interfascial injection approach without nerve stimulation","volume":"34","author":"Sinha","year":"2009","journal-title":"Reg Anesth Pain 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