Purushothaman Jithesh, Kalra Sidhartha, Dorairajan Lalgudi Narayanan, Selvarajan Sandhiya, Sreerag K S, Aggarwal Deepanshu
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Indian J Urol. 2024 Jul-Sep;40(3):161-166. doi: 10.4103/iju.iju_431_23. Epub 2024 Jul 1.
The objectives of this study were to investigate the efficacy and safety of intravesical bupivacaine instillation in reducing catheter-related bladder discomfort (CRBD) and lower urinary tract symptoms (LUTS) after transurethral surgery.
The study enrolled 100 American Society of Anesthesiologists (ASA) grade I-III patients aged ≥18 years undergoing transurethral resection of the prostate or transurethral resection of the bladder tumor, randomly assigned to Group B (intravesical bupivacaine) or Group S (saline). Double blinding was employed. Independent variables included demographics, surgery type, ASA grade, and intervention details. Dependent variables comprised CRBD severity, Patient Perception of Bladder Condition (PPBC), Pelvic Pain Urgency Frequency (PUF), Visual Analog Scale (VAS) for pain, need for additional analgesics, and International Prostate Symptom Score (IPSS). SPSS version 19 was used for analysis with a significance level of < 0.05. Side effects such as hematuria were also recorded.
Group B reported significantly lower "moderate" CRBD immediately (2% vs. 40%, < 0.001) and at 12 h (0% vs. 18%, = 0.003) post-instillation compared to Group S and also required fewer additional analgesics (4% vs. 46%). The PPBC at catheter removal also favored Group B ( = 0.003) and day 1 ( < 0.001). The PUF scores were also significantly lower in Group B at catheter removal ( = 0.001) and at day 1 ( = 0.028). The IPSS was also significantly lower in the Group B on day 1 ( = 0.003) and 7 ( = 0.001). The VAS scores also favored the Group B consistently and although the side effects were higher in Group B but this was not statistically significant.
Intravesical bupivacaine administration has the potential to alleviate CRBD and postoperative LUTS following lower urinary tract transurethral electrosurgery. The study's findings underscore the importance of personalized pain management strategies in optimizing the patient comfort during the postoperative recovery.
本研究的目的是探讨经尿道手术后膀胱内注入布比卡因在减轻导管相关膀胱不适（CRBD）和下尿路症状（LUTS）方面的疗效和安全性。
该研究纳入了100例年龄≥18岁、美国麻醉医师协会（ASA）分级为I-III级、接受经尿道前列腺切除术或经尿道膀胱肿瘤切除术的患者，随机分为B组（膀胱内注入布比卡因）和S组（生理盐水）。采用双盲法。自变量包括人口统计学数据、手术类型、ASA分级和干预细节。因变量包括CRBD严重程度、患者对膀胱状况的感知（PPBC）、盆腔疼痛尿急频率（PUF）、疼痛视觉模拟量表（VAS）、额外镇痛药的需求以及国际前列腺症状评分（IPSS）。使用SPSS 19版进行分析，显著性水平<0.05。还记录了血尿等副作用。
与S组相比，B组在注入后立即（2%对40%，<0.001）和12小时（0%对18%，=0.003）报告的“中度”CRBD明显更低，且所需额外镇痛药也更少（4%对46%）。拔除导管时的PPBC也有利于B组（=0.003）和第1天（<0.001）。拔除导管时（=0.001）和第1天（=0.028）B组的PUF评分也显著更低。第1天（=0.003）和第7天（=0.001）B组的IPSS也显著更低。VAS评分也始终有利于B组，尽管B组的副作用更高，但这在统计学上并不显著。
膀胱内注入布比卡因有可能缓解下尿路经尿道电切术后的CRBD和术后LUTS。该研究结果强调了个性化疼痛管理策略在优化患者术后恢复舒适度方面的重要性。
