Easy method to determine fluid responsiveness in septic shock patients: end-tidal CO2 - a prospective observational study.

BACKGROUND: In critically ill patients, especially those with septic shock, fluid management can be a challenging aspect of clinical care. One of the primary steps in treating patients with hemodynamic instability is optimizing intravascular volume. The Passive Leg Raising (PLR) maneuver is a reliable test for assessing fluid responsiveness, as demonstrated by numerous studies and meta-analyses. However, its use requires the measurement of cardiac output, which is often complex and may necessitate clinician experience and specialized equipment. End-Tidal Carbon Dioxide (ETCO2) measurement is relatively easy and is generally stable under steady metabolic conditions. It depends on the body's CO2 production, diffusion of CO2 from the lungs into the bloodstream, and cardiac output. If the other two parameters (metabolic conditions and minute ventilation) are constant, ETCO2 can provide information about cardiac output. The aim of the present study is to investigate the sensitivity of ETCO2 measurement in demonstrating fluid responsiveness. METHODS: All patients diagnosed with septic shock and meeting the inclusion criteria were subjected to a passive leg raising test, and cardiac outputs were measured by echocardiography. An increase in cardiac output of 15% or more was considered indicative of the fluid responder group, while patients with an increase below 15% or no increase were classified as the non-responder group. Patients' intensive care unit admission diagnoses, initial laboratory parameters, tidal volume, minute volume before and after the PLR maneuver, mean and systolic blood pressure, heart rate, Pulse Pressure Variation (PPV) values, and ETCO2 values were recorded. RESULTS: Before and after the ETCO2 test, there was no statistically significant difference between the two groups. However, the change in ETCO2 (ΔETCO2) was significantly higher in the responder group. In the non-responder group, ΔETCO2 was 2.57% (0.81), whereas it was 5.71% (2.83) in the responder group (p<0.001). Receiver Operating Characteristic (ROC) analysis was performed for ΔETCO2, baseline Stroke Volume Variation (SVV), ΔSVV, baseline Heart Rate (HR), ΔHR, baseline PPV, and ΔPPV to predict fluid responsiveness. ΔETCO2 predicted fluid responsiveness with a sensitivity of 85% and a specificity of 86% when it was 4% or higher. When ΔETCO2 was 5% or higher, it predicted fluid responsiveness with a specificity of 99.3% and a sensitivity of 75.5%, with an Area Under the Curve (AUC) of 0.89 (95% confidence interval, 0.828-0.961). CONCLUSION: This study demonstrates that in septic patients, ETCO2 during the PLR test can indicate fluid responsiveness with high sensitivity and specificity and can be used as an alternative to cardiac output measurement.

Effect of Prewarming on Skin Temperature Changes After Spinal Anesthesia in Transurethral Resection of the Bladder.

PURPOSE: Monitoring of peripheral skin temperature changes is an objective and rapid method to evaluate the success of neuraxial block after spinal anesthesia. The aim of this study is to investigate the effect of prewarming on peripheral temperature changes after the administration of spinal anesthesia. DESIGN: Randomized, prospective, single-blind study. METHODS: In this study, patients scheduled for transurethral resection of the bladder surgery under spinal anesthesia were divided into two groups: those with active prewarming and those without active prewarming. The groups were compared in core and skin temperature changes after administration of spinal anesthesia, length of stay in the postanesthesia care unit, shivering score, and the thermal comfort scale. FINDINGS: A statistically significant difference was found between the groups on time for a 1 °C increase in ankle and toe skin temperatures (P < .001). There was a statistically significant difference between the groups in core temperature measurements (P < .001). When thermal comfort was compared between the groups, a statistically significant difference was found (P < .001). Patients' shivering score (P = .704), and length of stay in the postanesthesia care unit (P = .059) between the groups were similar. CONCLUSIONS: Skin temperature changes in the prewarming group were lower, and this group had a lower rate of increase than the nonprewarming group. Therefore, skin temperature changes in the lower extremity can be used to determine the success of spinal anesthesia in patients who are prewarmed, with the awareness of these differences.

Success of the Cytokine Absorption Therapies in COVID-19 Patients Diagnosed with Cytokine Release Syndrome.

OBJECTIVE: To compare the effects of cytokine absorption therapy with a resin-based cytokine absorption cartridge to tocilizumab treatment in critically ill COVID-19 patients diagnosed with cytokine release syndrome (CRS). STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey from April 2020 to April 2021. METHODOLOGY: Twenty-four intensive care unit (ICU) patients were included in the study. Inclusion criteria were diagnosis of severe COVID-19, diagnosis of CRS and age of older than 18 years. Exclusion criteria were pregnancy, malignancy, prior COVID-19 vaccination, procalcitonin levels higher than 2 ng/ml and life-threatening comorbidities before ICU admission. Twelve patients received tocilizumab and the other 12 patients received cytokine absorption therapy. The groups were compared for clinical outcomes and inflammatory markers (CRP, fibrinogen, ferritin, D-dimer). RESULTS: Inflammatory markers showed smilar changes with both treatments, mostly toward improvement, on the same post-treatment days. The mortality rate was 58% (seven patients) in the cytokine absorption group and 50% (six patients) in the tocilizumab group (p = 0.682). CONCLUSION: It was found that the cytokine absorption therapy reduces inflammatory mediators in intubated and critically ill Covid-19 patients similar to tocilizumab treatment, and both treatments have comparable clinical outcomes. KEY WORDS: SARS-CoV-2, Cytokine release syndrome, Chemokines, Absorption, Tocilizumab.

Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study.

BACKGROUND AND OBJECTIVES: We aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair. METHODS: This study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) physical status I, II, or III, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics. RESULTS: The pain scores at 6 hours (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery. CONCLUSIONS: Our findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.

Unexpectedly prolonged fasting and its consequences on elderly patients undergoing spinal anesthetics. A prospective observational study1.

PURPOSE: To measure the preoperative fasting durations with respect to time of the day and its effect on vital parameters and electrocardiogram in elderly patients undergoing surgery under spinal anesthesia. METHODS: This study investigated 211 patients older than 60 years undergoing elective surgery under spinal anesthesia. Patients scheduled for surgery in morning hours (AM) and afternoon hours (PM) were compared. Patients fasting hours and repeated measurements of mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp02) and the type and number of ischemic electrocardiogram (ECG) signs were recorded and compared [preoperative, zeroth, 2nd,5th,15th,30th minutes following spinal anesthesia(SA)]. RESULTS: Mean fasting durations were 12±2.8 and 9.5±2.1 hours in AM group and 15.5±3.4 12.7±4.4 hours in PM group for foods and liquids respectively. ECG changes were significantly more frequent in PM group and body temperatures were significantly higher in AM group patients. CONCLUSION: Our study has shown that fasting times in our population is far longer than recommended and fasting prolonged>15 hours is related to a transiently increased cardiac stress and mild hypothermia.

Unexpectedly prolonged fasting and its consequences on elderly patients undergoing spinal anesthetics. A prospective observational study

Abstract Purpose: To measure the preoperative fasting durations with respect to time of the day and its effect on vital parameters and electrocardiogram in elderly patients undergoing surgery under spinal anesthesia. Methods: This study investigated 211 patients older than 60 years undergoing elective surgery under spinal anesthesia. Patients scheduled for surgery in morning hours (AM) and afternoon hours (PM) were compared. Patients fasting hours and repeated measurements of mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp02) and the type and number of ischemic electrocardiogram (ECG) signs were recorded and compared [preoperative, zeroth, 2nd,5th,15th,30th minutes following spinal anesthesia(SA)]. Results: Mean fasting durations were 12±2.8 and 9.5±2.1 hours in AM group and 15.5±3.4 12.7±4.4 hours in PM group for foods and liquids respectively. ECG changes were significantly more frequent in PM group and body temperatures were significantly higher in AM group patients. Conclusion: Our study has shown that fasting times in our population is far longer than recommended and fasting prolonged>15 hours is related to a transiently increased cardiac stress and mild hypothermia.

Effect of video-based education on anxiety and satisfaction of patients undergoing spinal anesthesia / Efeito de informações por meio de vídeo sobre a ansiedade e satisfação de pacientes submetidos à anestesia espinhal

Abstract Background: Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video-based education on anxiety and satisfaction in patients about to undergo spinal anesthesia. Methods: A total of 198 patients scheduled for minor elective surgery under spinal anesthesia were prospectively enrolled. The State-Trait Anxiety Inventory (State-Trait Anxiety Inventory/State and State-Trait Anxiety Inventory/Trait) questionnaires and visual analog scale were used to measure anxiety levels before the standard anesthesia evaluation was initiated. Then, 100 patients in Group 1 received written, verbal, and video-based education, whereas 98 patients in Group 2 received only written and verbal instructions regarding spinal anesthesia. Then all participants completed the State-Trait Anxiety Inventory/State and visual analog scale to evaluate anxiety. Finally, a 5-point Likert scale was used to measure satisfaction during postoperative period. Results: No differences were found in the State-Trait Anxiety Inventory/State, State-Trait Anxiety Inventory/Trait, or visual analog scale scores between the two groups before the information period. The State-Trait Anxiety Inventory/State scores evaluating anxiety during the post-information period were differed in both groups and they found as 36.5 ± 10.0 in Group 1 and 39.6 ± 8.6 in Group 2 (p = 0.033). The 5-point Likert scale scores to measure satisfaction were stated as 4.5 ± 0.6 in Group 1 and 3.5 ± 1.2 in Group 2 (p < 0.001). Conclusions: Providing video-based information during the preanesthetic interview alleviated anxiety and increased satisfaction in patients undergoing spinal anesthesia.

Resumo Justificativa: Fornecer informação suficiente durante uma consulta pré-anestesia pode aumentar a compreensão do paciente e diminuir a ansiedade relacionada à anestesia espinhal. Investigamos o efeito do fornecimento de informação via vídeo sobre a ansiedade e satisfação em pacientes prestes a serem submetidos à anestesia espinhal. Métodos: Foram inscritos prospectivamente 198 pacientes agendados para cirurgias eletivas de pequeno porte sob anestesia espinhal. Os questionários de avaliação de estado e traço de ansiedade (State-Trait Anxiety Inventory/State e State-Trait Anxiety Inventory/Trait) e uma escala visual analógica foram usados para medir os níveis de ansiedade antes de a avaliação-padrão da anestesia ter sido iniciada. Em seguida, 100 pacientes do Grupo 1 receberam informação por escrito, verbal e via vídeo, enquanto 98 pacientes do Grupo 2 receberam apenas informação por escrito e verbal sobre a anestesia espinhal. Em seguida, todos os participantes responderam os inventários de estado e traço de ansiedade e a escala visual analógica para avaliar a ansiedade. Por fim, a escala de Likert de 5 pontos foi usada para medir a satisfação durante o período pós-operatório. Resultados: Não houve diferença nos escores dos questionários de estado e traço de ansiedade e da escala visual analógica entre os dois grupos antes do período de informação. Os escores de estado e traço de ansiedade que avaliam a ansiedade durante o período pós-informação foram diferentes em ambos os grupos: 36,5 ± 10,0 no Grupo 1 e 39,6 ± 8,6 no Grupo 2 (p = 0,033). Os escores da escala Likert de 5 pontos para medir a satisfação foram: 4,5 ± 0,6 no Grupo 1 e 3,5 ± 1,2 no Grupo 2 (p < 0,001). Conclusão: Fornecer informação via vídeo durante a consulta pré-anestésica aliviou a ansiedade e aumentou a satisfação em pacientes submetidos à anestesia espinhal.

[Effect of video-based education on anxiety and satisfaction of patients undergoing spinal anesthesia]. / Efeito de informações por meio de vídeo sobre a ansiedade e satisfação de pacientes submetidos à anestesia espinhal.

BACKGROUND: Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video-based education on anxiety and satisfaction in patients about to undergo spinal anesthesia. METHODS: A total of 198 patients scheduled for minor elective surgery under spinal anesthesia were prospectively enrolled. The State-Trait Anxiety Inventory (State-Trait Anxiety Inventory/State and State-Trait Anxiety Inventory/Trait) questionnaires and visual analog scale were used to measure anxiety levels before the standard anesthesia evaluation was initiated. Then, 100 patients in Group 1 received written, verbal, and video-based education, whereas 98 patients in Group 2 received only written and verbal instructions regarding spinal anesthesia. Then all participants completed the State-Trait Anxiety Inventory/State and visual analog scale to evaluate anxiety. Finally, a 5-point Likert scale was used to measure satisfaction during postoperative period. RESULTS: No differences were found in the State-Trait Anxiety Inventory/State, State-Trait Anxiety Inventory/Trait, or visual analog scale scores between the two groups before the information period. The State-Trait Anxiety Inventory/State scores evaluating anxiety during the post-information period were differed in both groups and they found as 36.5±10.0 in Group 1 and 39.6±8.6 in Group 2 (p=0.033). The 5-point Likert scale scores to measure satisfaction were stated as 4.5±0.6 in Group 1 and 3.5±1.2 in Group 2 (p<0.001). CONCLUSIONS: Providing video-based information during the preanesthetic interview alleviated anxiety and increased satisfaction in patients undergoing spinal anesthesia.

Anaesthetic Management of a Patient with Brugada Syndrome.

Brugada Syndrome is a condition with an undetermined aetiology and a tendency for malignant arrhythmias, an electrocardiographic pattern of a right bundle branch block with persistent ST segment elevation in the right precordial leads (V1-V3) and no association with structural heart disease. We aimed to discuss the anaesthetic management of an asymptomatic 35-year-old patient with Brugada syndrome who had been diagnosed during the pre-anaesthetic assessment because of the family history of the early sudden cardiac death of his mother. As a result, we believe that detailed patient history and careful examination of laboratory tests and electrocardiography are crucial for early diagnosis of some diseases and for successful anaesthetic management.

Comparison Between Ultrasonography-Guided Popliteal Sciatic Nerve Block and Spinal Anesthesia for Hallux Valgus Repair.

BACKGROUND: We aimed to compare the efficacy, postoperative pain scores, adverse effects, additional analgesic requirements, and patient satisfaction scores of ultrasonography-guided sciatic nerve block by popliteal approach with spinal anesthesia for hallux valgus correction surgery. METHODS: Sixty patients scheduled for hallux valgus correction surgery were enrolled in this prospective randomized study. Unilateral spinal block was performed on patients in the spinal anesthesia group. Popliteal block group patients received popliteal sciatic nerve block with guidance by both nerve stimulator and ultrasonography. Durations of anesthetic and operative interventions and time until the initiation of surgery were recorded for both groups. Pain magnitude of the patients at the 2nd, 4th, 6th, 12th, and 24th hours following anesthetic interventions were assessed with a visual analog scale (VAS). Adverse effects such as postoperative urinary retention and postdural puncture headache were recorded. Also, patient satisfaction was recorded. Patients were interviewed by phone for anesthetic and operative complications at 72 hours postoperatively. RESULTS: Spinal anesthesia group patients exhibited hypotension, bradycardia, postdural puncture headache, and urinary retention rates of 6.6%, 3.3%, 10%, and 3.3%, respectively. Popliteal block group patients showed none of these adverse effects. Moreover, VAS scores of the patients at the 2nd, 4th, 6th, and 12th hours were significantly lower (P < .001, P = .003, P < .001, P <.001, respectively), postoperative first analgesic requirement times were significantly longer (P < .001), and pain satisfaction scores were significantly higher (P < .001) in the popliteal block group. CONCLUSION: Given the complications related to spinal anesthesia and its insufficiency to maintain analgesia postoperatively, we believe the preferred anesthetic method should be peripheral nerve blocks for hallux valgus correction surgeries. LEVEL OF EVIDENCE: Level I, randomized prospective study.

Impact of nerve stimulator-guided obturator nerve block on the short-term outcomes and complications of transurethral resection of bladder tumour: A prospective randomized controlled study.

INTRODUCTION: In this prospective randomized controlled study, we investigated the efficacy of obturator nerve block (ONB) on adductor muscle spasm and related short-term outcomes and complications in patients who underwent transurethral resection of lateral wall-located bladder tumours (TURBT). METHODS: Between July 2014 and February 2015, 70 patients scheduled to undergo TUR of lateral bladder wall tumours were enrolled in the study. All patients were preoperatively evaluated by cystoscopy and imaging tools and selected according to localized tumours on the lateral bladder wall. Patients were randomly allocated to Group SA (35 patients who underwent only spinal anesthesia) and Group ONB (35 patients who underwent spinal anesthesia combined with ONB by the nerve stimulator). An independent observer, blinded to the approach, evaluated the obturator signs, including adductor muscle contraction, bladder perforation, and completeness of the resection during the TURBT procedure. RESULTS: The differences between groups regarding mean operation time, tumour size, and number were not statistically significant (p > 0.05). Adductor muscle contraction was detected in 40% of patients in Group SA and 11.4% in Group ONB. This difference was statistically significant (p = 0.021). Complete bladder perforation was detected in 2 patients in Group SA, whereas no perforation was observed in Group ONB. There was no case of severe bleeding in both groups. CONCLUSIONS: We found that ONB performed after spinal anesthesia was effective in preventing intraoperative complications due to adductor muscle spasm while performing TURBT. Our study limitations include its small sample size, since we only enrolled patients with primary lateral wall-localized bladder tumour. Also, we excluded patients who underwent bipolar TURBT.

Effects of dexmedetomidine and propofol on sedation in patients after coronary artery bypass graft surgery in a fast-track recovery room setting.

PURPOSE: We aim to compare the effects of propofol and dexmedetomidine infusions on extubation times, hemodynamic and respiratory functions, complication rates and patient satisfaction scores in patients undergoing coronary artery bypass graft (CABG) surgery using a fast-track anesthesia regimen for early extubation. METHODS: We enrolled 64 patients who underwent CABG surgery. Dexmedetomidine (min 0.2 µg/kg/h-max 1.0 µg/kg/h) and propofol (min 1.0 mg/kg/h-max 3.0 mg/kg/h) infusion doses were titrated to give bispectral index values between 60 and 90 and a Ramsay sedation score (RSS) between 3 and 4. Postoperative extubation times, patient satisfaction and postoperative adverse events were recorded. RESULTS: The mean times to extubation were 265.94 ± 43.1 min for the dexmedetomidine group and 322.52 ± 39.2 min for the propofol group (P < 0.001). In all recordings, RSS median values for the propofol group were significantly lower than the dexmedetomidine group (P < 0.05). There were no differences in the incidence of postoperative adverse events between the dexmedetomidine and propofol groups. There was a statistically significant difference between patient satisfaction median values of the two groups-7 (5-9) and 9 (7-10) (min-max) for the propofol and dexmedetomidine groups, respectively (P < 0.001). CONCLUSION: Our results show that dexmedetomidine can easily be preferred over propofol in fast-track cardiac anesthesia due to its significant advantages of shorter extubation time and higher postoperative patient satisfaction scores.

Radiological Evaluation of the Line Between the Crista Iliaca (Tuffier's line) in Elderly Patients.

OBJECTIVE: Tuffier's line is defined as the line connecting the highest points of both iliac crests, which generally passes through either the body of the fourth lumbar vertebra or the intervertebral space between fourth and fifth vertebrae. In this study, we assessed the radiological correlation of the level of Tuffier's line with changes in age and sex. METHODS: In this study, antero-posterior pelvic X-rays of 590 patients aged 18 and older were retrospectively analyzed. It is revealed that Tuffier's line crosses the vertebral column at one of three levels, which are the L4 vertebral body, L4-L5 vertebral interspace and L5 vertebral body. Patients' sex, age and vertebral level of the Tuffier's line were recorded. Data was analyzed using the chi-square test. RESULTS: The assessment of the X-rays of 317 female patients showed that Tuffier's Line passes through the L4 vertebral body in 115 (37.8%), through the L4-L5 intervertebral space in 126 (40%) and through the L5 vertebral body in 76 (22.2%) patients. A Tuffier's line passing through the level of the L5 vertebral body was found to be statistically significant in female patients (p=0.00). No significant relevance was found between male gender and the level of Tuffier's line in 273 male patients. It is found that the height of the vertebral levels that Tuffier's line crosses does not correlate with mean age of the groups (p=0.939). CONCLUSION: It should be considered that Tuffier's line can cross at vertebral levels other than anticipated. The level of Tuffier's line should be precisely determined with supplementary radiological methods, such as AP pelvic X-ray in addition to physical examination, to reduce the complications in association with regional anaeshesia and to achieve sensorial block levels sufficient to sustain a comfortable surgery, particularly in female patients who carry higher cardiac and respiratory risks.

A prospective randomized double-blind study on the effects of the temperature of irrigation solutions on thermoregulation and postoperative complications in percutaneous nephrolithotomy.

PURPOSE: This study investigated the effects of irrigation solutions, administered at either 21 or 37 °C in percutaneous nephrolithotomy (PCNL), on hypothermia and related postoperative complications such as late emergence and late recovery from anesthesia, shivering, lactic acidosis, and excess bleeding. METHODS: Sixty patients who were scheduled for PCNL were enrolled in this prospective randomized double-blind study. Irrigation solutions at room temperature were administered to patients in group R (30 patients), and warmed irrigation solutions were administered to patients in group W (30 patients). The two groups were compared for core and peripheral body temperature, incidence of hypothermia, duration of emergence from anesthesia, duration of recovery from anesthesia, shivering, lactic acidosis, and hemoglobin levels. RESULTS: Hypothermia was incident in 19 patients (63.3 %) in group W and in 27 patients (90 %) in group R at the end of surgery. The difference between the initial and the final core body temperature was 0.9 ± 0.6 °C group W and 1.4 ± 0.7 °C in group R (p = 0.003). The extubation time was 4.4 ± 2.2 min in group W and 5.9 ± 3 min in group R (p = 0.032). Shivering was detected in seven patients (23.3 %) in group W and in 15 patients (50 %) in group R (p = 0.032). The recovery duration was 49.8 ± 24.6 min in group W and 67.6 ± 33.9 min in group R (p = 0.023). CONCLUSIONS: Administration of irrigation solutions at room temperature in PCNL operations causes the body temperature to decrease significantly, which results in postoperative complications such as late emergence from anesthesia, late recovery from anesthesia, and shivering.

Impact of obturator nerve block on the short-term recurrence of superficial bladder tumors on the lateral wall.

PURPOSE: The aim of this study was to compare the recurrence rates of patients with bladder tumors on the lateral wall undergoing transurethral resection of bladder tumor(TUR-BT) with or without obturator nerve block (ONB) and to investigate the impact of ONB on the effective tumor resection on the lateral bladder wall. MATERIALS AND METHODS: All patients who underwent TUR-BT under spinal anesthesia within the three-year study period in the study center were reviewed retrospectively. Among these, 68 patients who had been diagnosed with de novo lateral bladder wall tumor and included in low risk group 1n accord with European Organization for Research and Treatment of Cancer (EORTC) classification, undergone complete resection were enrolled into the study. Group 1 (36 patients who underwent TUR-BT with only spinal anesthesia) and group 2 (32 patients who underwent TUR-BT with spinal anesthesia plus ONB) were evaluated with respect to tumor recurrence rates and disease-free time to recurrence, if any. RESULTS: Follow-up periods (range, 19 to 41 months for group 1 and 19 to 39 months for group 2) and overall recurrence rates (group 1, 27.8% and group 2, 18.8%) were also found to be similar. Mean time to recurrence was significantly higher in group 2 (15 ± 5.5 months) than in group 1 (7.8 ± 4.5 months) (P = .009) CONCLUSION: ONB employed in addition to spinal anesthesia in TUR-BT involving the lateral wall can prolong time to recurrence and increase the chance to lengthen disease-free survival in low-risk superficial bladder tumors.