What is the commonest cause of periumbilical pain after 30 minutes of TURP done under spinal anesthesia with Bupivacaine?

The incidence of bladder perforation during TURP is less than 1%. This patient experiences pain 30 minutes after TURP. This is because he is under spinal anesthesia. Perforation may result from the resectoscope going through the bladder wall or from overdistention of the bladder with irrigation fluid. Most bladder perforations are extraperitoneal and are signaled by poor return of the irrigating fluid. Awake patients will typically complain of nausea, diaphoresis, and retropubic or lower abdominal pain. Large extraperitoneal and most intraperitoneal perforations are presenting as sudden unexplained hypotension or hypeension, and with generalized abdominal pain in awake patients. Regardless of the anesthetic technique employed, perforation should be suspected in settings of sudden hypotension or hypeension, paicularly with acute, vagally mediated bradycardia. Ref: Butterwoh IV J.F., Butterwoh IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C., Wasnick J.D. (2013). Chapter 31. Anesthesia for Genitourinary Surgery. In J.F. Butterwoh IV, J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e.