Etezadi Farhad, Sajedi Yasamin, Khajavi Mohammad Reza, Moharari Reza Shariat, Amirjamshidi Abbas
Department of Anesthesiology and critical care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Asian J Neurosurg. 2018 Oct-Dec;13(4):1057-1060. doi: 10.4103/ajns.AJNS_314_17.
Catheter-related bladder discomfort (CRBD) is one of the main reasons of agitation after surgery, leading to urgency and frequency during recovery. Ketamine has been used as an effective drug for reducing the signs and severity of this problem. We hypothesized that intraurethral instillation of ketamine-lidocaine gel before urinary catheterization can reduce the incidence of CRBD in the postoperative period.
A total of 136 male patients, who underwent two-level laminectomy/discectomy were enrolled in this randomized clinical trial. Patients were randomized into the two groups before urinary catheterization. The ketamine group received urethral lubrication with 5 mL xylocaine jelly (2%) in conjunction with 2 mL (100 mg) ketamine. Patients in control group received urethral lubrication with 5 mL xylocaine jelly (2%) in conjunction with 2 mL distilled water. The primary outcome was the incidence of CRBD. CRBD was assessed using four-stage criteria when arriving in the recovery room and at 1, 2, and 6 h after surgery. Postsurgical pain and the number of sedatives given and opioid requirement were also the secondary outcomes in this study.
Intraurethral instillation of ketamine-lidocaine gel reduced the incidence of CRBD at recovery ( < 0.001) along with a reduction in the severity of CRBD ( < 0.05) during the 1 and 2 visit compared with control group. The mean pain intensity score (visual analog scale) and opioid requirement to relieve postsurgical pain were lower in the ketamine group during all the study timepoints from recovery and after transfer to the ward ( < 0.008). A higher rate of sedation (72% vs. 11%) also was seen at recovery period in the ketamine group ( < 0.008).
Intraurethral instillation of ketamine-lidocaine gel before bladder catheterization is an effective technique for reducing the incidence and severity of postoperative CRBD.
导尿管相关膀胱不适（CRBD）是术后躁动的主要原因之一，导致恢复期间出现尿急和尿频。氯胺酮已被用作减轻该问题症状和严重程度的有效药物。我们假设在导尿前经尿道灌注氯胺酮-利多卡因凝胶可降低术后CRBD的发生率。
本随机临床试验共纳入136例行两级椎板切除术/椎间盘切除术的男性患者。在导尿前将患者随机分为两组。氯胺酮组使用5 mL（2%）利多卡因凝胶联合2 mL（100 mg）氯胺酮进行尿道润滑。对照组患者使用5 mL（2%）利多卡因凝胶联合2 mL蒸馏水进行尿道润滑。主要结局是CRBD的发生率。在进入恢复室时以及术后1、2和6小时，使用四阶段标准评估CRBD。术后疼痛、给予镇静剂的数量和阿片类药物需求也是本研究的次要结局。
与对照组相比，经尿道灌注氯胺酮-利多卡因凝胶可降低恢复时CRBD的发生率（<0.001），并在第1次和第2次访视时降低CRBD的严重程度（<0.05）。在从恢复到转入病房的所有研究时间点，氯胺酮组的平均疼痛强度评分（视觉模拟量表）和缓解术后疼痛所需的阿片类药物用量均较低（<0.008）。氯胺酮组在恢复期间的镇静率也更高（72%对11%）（<0.008）。
在膀胱导尿前经尿道灌注氯胺酮-利多卡因凝胶是降低术后CRBD发生率和严重程度的有效技术。
