Prajapati Dinesh J, Patel Manoj, Patel Pankaj, Vijayakumar Mohankumar, Ganpule Arvind, Mistry Deepak
Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):524-530. doi: 10.4103/joacp.JOACP_285_18. Epub 2021 Jan 18.
Catheter-related bladder discomfort (CRBD) is a major cause of postoperative morbidity following urological procedures. The aim of this study was to compare the effect of caudal bupivacaine alone and with adjuvant fentanyl and nalbuphine to minimize the severity of CRBD after tubeless percutaneous nephrolithotomy (PCNL).
A randomized prospective study was conducted on one hundred thirty-two (American society of Anaesthesiologist physical status I to II) patients who presented for tubeless PCNL under general anesthesia. Patients were randomly divided into four groups control (C), bupivacaine (B), bupivacaine-fentanyl (BF), and bupivacaine-nalbuphine (BN) by using computer-generated codes. All patients received local infiltration at the procedure site while Groups B, BF, and BN received caudal epidural block (CEB) under ultrasound guidance after conclusion of the procedure. Groups B, BF, and BN received bupivacaine alone, bupivacaine-fentanyl, and bupivacaine-nalbuphine, respectively, for CEB. Patients were monitored 24 h for CRBD scale, visual analogue score (VAS), and duration of analgesia at 30 min, 1, 2, 4, 6, 12, 18, and 24 h intervals. The analgesics were supplemented if the CRBD score was >2 and VAS was ≥4. Student t-test, analysis of variance, and Chi-square test were applied for quantitative, within group occurrence, and qualitative analysis respectively.
The CRBD scores were considerably lower in the Groups BF and BN as compared to Groups C and B during the first four hours. The duration of analgesia was significantly prolonged in Group BN (475 ± 47 min) versus BF (320 ± 68 min) versus B (104 ± 40 min) versus C (26 ± 14 min).
The severity of CRBD can be reduced with CEB. The effect of CEB can be prolonged with the addition of opioid.
导尿管相关膀胱不适（CRBD）是泌尿外科手术后发病的主要原因。本研究的目的是比较单纯尾骶部布比卡因以及联合使用辅助药物芬太尼和纳布啡对减少无管经皮肾镜取石术（PCNL）后CRBD严重程度的效果。
对132例（美国麻醉医师协会身体状况分级为I至II级）在全身麻醉下接受无管PCNL的患者进行了一项随机前瞻性研究。使用计算机生成的编码将患者随机分为四组：对照组（C）、布比卡因组（B）、布比卡因-芬太尼组（BF）和布比卡因-纳布啡组（BN）。所有患者在手术部位接受局部浸润麻醉，而B组、BF组和BN组在手术结束后于超声引导下接受尾骶部硬膜外阻滞（CEB）。B组、BF组和BN组分别在CEB时单独使用布比卡因、布比卡因-芬太尼和布比卡因-纳布啡。在术后24小时内，每隔30分钟、1小时、2小时、4小时、6小时、12小时、18小时和24小时对患者进行CRBD量表、视觉模拟评分（VAS）以及镇痛持续时间的监测。如果CRBD评分>2且VAS≥4，则补充镇痛药。分别应用学生t检验、方差分析和卡方检验进行定量分析、组内发生率分析和定性分析。
在前四个小时内，BF组和BN组的CRBD评分显著低于C组和B组。BN组的镇痛持续时间（475±47分钟）显著长于BF组（320±68分钟）、B组（104±40分钟）和C组（26±14分钟）。
CEB可降低CRBD的严重程度。添加阿片类药物可延长CEB的效果。
