Adamopoulos Vasileios G, Filiadis Ioannis, Konstandinidis Erotokritos
Department of Urology, General Hospital of Kavala, Kavala, Greece.
Int Braz J Urol. 2008 May-Jun;34(3):277-81; discussion 281-2. doi: 10.1590/s1677-55382008000300004.
To estimate the level of analgesia which can be obtained with simple intravesical instillation of ropivacaine in comparison to the combination of both instillation and subepithelial injection of the same agent.
Fifty-two patients were randomized in order that half (26) of them received simple intravesical instillation of ropivacaine (100 mL solution of ropivacaine in a concentration of 2 mg/mL) (Group A), whereas the other 26 patients received both intravesical instillation and subepithelial injection of 2 mL (4 mg) at the site of biopsy (Group B). In both groups, tissue samples were obtained from urinary bladder (number of biopsies from 3 to 4). The pain during the procedure was estimated by using the Visual Analogue Scale (VAS) which ranged from 0 to 10.
The entire procedure was integrated with success in 50 out of 52 patients. The VAS score for the Group A ranged from 4 to 6 (mean 5.08), whereas for Group B from 1 to 3 (mean 1.6). (p<0.0001). Higher values of VAS score were recorded in males in both Groups (p<0.05). When complications of this method produced a slight bleeding (hematuria) in 6 patients (2 from group B and 4 from group A), they were treated with oral administration of fluids. Allergic reactions were not recorded. Hospitalization did not exceed 3 hours after the procedure.
The analgesic effect that was obtained with the combination of intravesical instillation and subepithelial injection of ropivacaine provides a safe method of anesthesia for transurethral bladder biopsy.
评估单纯膀胱内灌注罗哌卡因与膀胱内灌注联合黏膜下注射罗哌卡因相比所能达到的镇痛水平。
52例患者被随机分组，其中一半（26例）接受单纯膀胱内灌注罗哌卡因（100 mL浓度为2 mg/mL的罗哌卡因溶液）（A组），而另外26例患者在活检部位接受膀胱内灌注及2 mL（4 mg）黏膜下注射（B组）。两组均从膀胱获取组织样本（活检次数为3至4次）。通过视觉模拟评分法（VAS，范围为0至10）评估操作过程中的疼痛程度。
52例患者中有50例成功完成整个操作。A组的VAS评分为4至6分（平均5.08分），而B组为1至3分（平均1.6分）（p<0.0001）。两组男性的VAS评分均较高（p<0.05）。该方法的并发症导致6例患者出现轻微出血（血尿）（B组2例，A组4例），通过口服补液进行治疗。未记录到过敏反应。术后住院时间不超过3小时。
膀胱内灌注联合黏膜下注射罗哌卡因所获得的镇痛效果为经尿道膀胱活检提供了一种安全的麻醉方法。
