Haleem Shahla, Ozair Ahmad, Singh Abhishek, Hasan Muazzam, Athar Manazir
Department of Anaesthesiology and Critical Care, J.N. Medical College, AMU, Aligarh, UP, India.
King George's Medical University, Lucknow, UP, India.
J Anaesthesiol Clin Pharmacol. 2020 Jan-Mar;36(1):94-99. doi: 10.4103/joacp.JOACP_221_18. Epub 2020 Feb 18.
Following spinal anesthesia (SA), patient discharge is often delayed due to postoperative urinary retention (POUR), the incidence of which varies widely. The present study of bupivacaine versus ropivacaine in equianalgesic doses was taken to explore the correlation between time to void urine and time for complete functional recovery.
In this double-blinded study fifty adult patients were assigned to two groups (bupivacaine/ropivacaine) according to alternate case allocation for receiving SA for lower abdominal, perineal, and lower limb surgeries, lasting less than 2 h. Statistical analysis was conducted using an intention-to-treat approach, using Mann-Whitney test for nonparametric data. Primary outcome data could not be obtained for 14 out of the 50 patients due to perioperative bladder catheterization. No patients were lost to follow-up.
Both the bupivacaine and ropivacaine groups were comparable in terms of ability to void (8.0 ± 2.3 vs. 7.0 ± 1.2 h; > 0.05), modified Bromage scale after 4 h of SA (1.8 ± 1.3 vs. 2.6 ± 0.9 grade; > 0.05), time to complete ambulation (6.7 ± 1.4 vs. 6.1 ± 1.0 h; > 0.05), and time to negative Romberg test (6.1 ± 1.4 vs. 5.6 ± 0.9 h; > 0.05), respectively. Strong positive correlations ( = 0.7-0.9) were found between time to void urine and time for complete ambulation.
Time to void urine and recovery of motor functions were found comparable statistically when bupivacaine and ropivacaine were used in the doses of 12.5 and 18.75 mg, respectively, for SA. However, group ropivacaine required lesser time to void and no patient developed POUR. Time to void urine was more than the time for ambulation. This may indicate a need for "selective spinal anesthesia" or adjuvant combination technique to accelerate the resolution of a block for ambulatory surgery.
脊髓麻醉（SA）后，患者常因术后尿潴留（POUR）导致出院延迟，其发生率差异很大。本研究采用等镇痛剂量的布比卡因与罗哌卡因进行对比，以探讨排尿时间与完全功能恢复时间之间的相关性。
在这项双盲研究中，50例成年患者根据交替病例分配法分为两组（布比卡因/罗哌卡因组），接受下腹部、会阴和下肢手术的SA，手术持续时间小于2小时。采用意向性分析方法进行统计分析，对非参数数据使用曼-惠特尼检验。由于围手术期膀胱插管，50例患者中有14例无法获得主要结局数据。无患者失访。
布比卡因组和罗哌卡因组在排尿能力（8.0±2.3 vs. 7.0±1.2小时；P>0.05）、SA 4小时后的改良 Bromage评分（1.8±1.3 vs. 2.6±0.9级；P>0.05）、完全行走时间（6.7±1.4 vs. 6.1±1.0小时；P>0.05）以及Romberg试验转阴时间（6.1±1.4 vs. 5.6±0.9小时；P>0.05）方面均具有可比性。排尿时间与完全行走时间之间存在强正相关（r=0.7-0.9）。
分别使用12.5mg和18.75mg布比卡因和罗哌卡因进行SA时，排尿时间和运动功能恢复在统计学上具有可比性。然而，罗哌卡因组排尿所需时间更短，且无患者发生POUR。排尿时间超过行走时间。这可能表明需要“选择性脊髓麻醉”或辅助联合技术来加速门诊手术阻滞的消退。
