Sur Roger L, Haleblian George E, Cantor David A, Springhart W Patrick, Albala David M, Preminger Glenn M
Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina, USA.
J Endourol. 2008 Mar;22(3):473-8. doi: 10.1089/end.2007.9847.
Previous studies suggest that intravesical administration of nonsteroidal anti-inflammatory drugs may reduce the troublesome voiding symptoms and pain related to ureteral stenting. The objective of this study was to investigate the effectiveness of a long-acting local anesthetic, ropivacaine, injected submucosally into the bladder to control ureteral stent-associated symptoms.
A randomized, single-blinded, study approved by our Institutional Review Board of adult patients scheduled for ureteroscopic stone surgery and possible stent placement was conducted. Patients were randomized to either the treatment cohort, who received five injections of 2 mL 0.5% ropivacaine around the ureteral orifice or to the control cohort, who received five injections of 2 mL of 0.9% normal saline in identical locations. Pain scale questionnaires were provided to each subject preoperatively and at postoperative hours 2, 4, 8, 24, and 48 as well as on the day of stent removal. Student's t test and Wilcoxon signed rank sum tests were used for Gaussian and nonparametric data, respectively.
Twenty-two patients were randomized evenly into the two cohorts. The ropivacaine group consisted of 11 patients (eight men and three women) with a mean age of 56.2 years (standard deviation [SD] = 12, range 27-69), and the saline group consisted of eleven patients (six men and five women) with a mean age of 47.8 years (SD = 6.6, range 37-58). Intraoperative parameters appeared similar between the two cohorts. Intraoperative and postoperative narcotic usage was not different between the two groups, except at postoperative hour 2 when it favored the ropivacaine cohort (P = 0.05). Trends favoring ropivacaine in flank pain, bladder pain, genitalia pain, and hematuria domains were seen as long as 8 hours and up to the day of stent removal. Trends of less magnitude and duration were seen in the dysuria domain. No differences were seen in the frequency and urgency domains.
Our preliminary investigation with intravesical injection of ropivacaine before ureteroscopic surgery demonstrated trends toward decreased pain and voiding symptoms in this small-sample study. Inclusion of a larger sample should definitively address the effectiveness of intravesical ropivacaine and its impact on stent-related symptoms.
先前的研究表明，膀胱内给予非甾体类抗炎药可能会减轻与输尿管支架置入相关的令人烦恼的排尿症状和疼痛。本研究的目的是探讨长效局部麻醉药罗哌卡因经膀胱黏膜下注射以控制输尿管支架相关症状的有效性。
开展了一项经我们机构审查委员会批准的随机、单盲研究，纳入计划接受输尿管镜取石手术且可能置入支架的成年患者。患者被随机分为治疗组和对照组，治疗组在输尿管口周围接受5次2 mL 0.5%罗哌卡因注射，对照组在相同位置接受5次2 mL 0.9%生理盐水注射。在术前、术后2小时、4小时、8小时、24小时和48小时以及支架取出当天，向每位受试者提供疼痛量表问卷。分别使用学生t检验和Wilcoxon符号秩和检验分析高斯分布数据和非参数数据。
22例患者被均匀随机分为两组。罗哌卡因组有11例患者（8例男性和3例女性），平均年龄56.2岁（标准差[SD]=12，范围27 - 69岁），生理盐水组有11例患者（6例男性和5例女性），平均年龄47.8岁（SD = 6.6，范围37 - 58岁）。两组的术中参数相似。两组术中及术后的麻醉药物使用情况无差异，但术后2小时罗哌卡因组使用量较少（P = 0.05）。在长达8小时直至支架取出当天，在胁腹疼痛、膀胱疼痛、生殖器疼痛和血尿方面，罗哌卡因组均有优势趋势。在排尿困难方面，优势趋势的程度和持续时间较短。在尿频和尿急方面无差异。
我们在输尿管镜手术前膀胱内注射罗哌卡因的初步研究表明，在这项小样本研究中，疼痛和排尿症状有减轻趋势。纳入更大样本应能明确解决膀胱内注射罗哌卡因的有效性及其对支架相关症状的影响。
