Intravenous Lidocaine for the Prevention of Postoperative Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized, Double-Blind, Controlled Trial
Intravenous Lidocaine for the Prevention of Postoperative Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized, Double-Blind, Controlled Trial
复制标题
DOI：
10.1213/ane.0000000000004405
复制
发表时间：
2020-07-01
影响因子：
5.7
通讯作者：
Kim, Young-Kug
中科院分区：
文献类型：
--
作者：
Kim, Doo-Hwan;Park, Jun-Young;Kim, Young-Kug
背景技术背景：男性患者在接受经尿道膀胱肿瘤电切术（TURBT）时容易出现导管相关性膀胱不适（CRBD）。利多卡因给药已被广泛用于减轻术后疼痛。在此，在接受TURBT的男性患者中评价了静脉注射利多卡因对中重度CRBD的影响。方法：患者随机分配接受静脉利多卡因（1.5 mg/kg推注剂量，然后在术中持续输注2 mg/kg/h，持续至术后1小时; L组）或安慰剂（生理盐水; C组）。主要结局是术后0小时（进入麻醉后监护室）的中度至重度CRBD，使用卡方检验进行分析。次要结局是术后24小时内的阿片类药物需求。还评估了术后1、2和6小时的无、轻度和中度至重度CRBD、术后疼痛、患者满意度、利多卡因和急救药物（曲马多和芬太尼）的副作用以及手术并发症。结果：共132例患者纳入研究（每组66例）。术后0小时中重度CRBD发生率L组显著低于C组（25.8%vs66.7%，P <0.001，相对危险度：0.386，95%可信区间：0.248-0.602）。术后24小时期间，L组的阿片类药物需求量显著低于C组（10.0 mg [四分位距（IQR），5.0-15.0 mg] vs 13.8 mg [IQR，10.0-20.0 mg]，P= 0.005）。在术后1和2小时（但不是6小时），L组中重度CRBD的发生率显著低于C组（1小时：10.6% vs 27.3%，P = 0.026; 2小时：0.0% vs 15.2%，P = 0.003）。L组患者满意度显著高于C组（5.0 [IQR，4.8-6.0] vs 4.0 [IQR，4.0-5.0]，P< .001）。未报告利多卡因相关副作用。急救药物相关的副作用和手术并发症在两组之间没有显著差异。结论：在接受TURBT的男性患者中，静脉注射利多卡因导致中重度CRBD的发生率较低，阿片类药物需求较低，患者满意度较高，无明显副作用的证据。
BACKGROUND: Male patients undergoing transurethral resection of bladder tumors (TURBT) are prone to suffer from catheter-related bladder discomfort (CRBD). Lidocaine administration has been widely performed to reduce postoperative pain. Here, the effect of intravenous lidocaine administration on moderate-to-severe CRBD was evaluated in male patients undergoing TURBT. METHODS: Patients were randomly allocated to receive intravenous lidocaine (1.5 mg/kg bolus dose followed by a 2 mg/kg/h continuous infusion during the intraoperative period, which was continued for 1 hour postsurgery; group L) or placebo (normal saline; group C). The primary outcome was moderate-to-severe CRBD at 0 hour postsurgery (on admission to the postanesthetic care unit), analyzed using the chi(2)test. The secondary outcome was opioid requirement during the 24-hour postoperative period. None, mild, and moderate-to-severe CRBD at 1, 2, and 6 hours postsurgery, postoperative pain, patient satisfaction, side effects of lidocaine and rescue medications (tramadol and fentanyl), and surgical complications were also assessed. RESULTS: A total of 132 patients were included in the study (66 patients in each group). The incidence of moderate-to-severe CRBD at 0 hour postsurgery was significantly lower in group L than in group C (25.8% vs 66.7%,P< .001, relative risk: 0.386, 95% confidence interval: 0.248-0.602). Opioid requirements during the 24-hour postoperative period were significantly lower in group L than in group C (10.0 mg [interquartile range (IQR), 5.0-15.0 mg] vs 13.8 mg [IQR, 10.0-20.0 mg],P= .005). At 1 and 2 hours postsurgery (but not at 6 hours), the incidence of moderate-to-severe CRBD was significantly lower in group L than in group C (1 hour: 10.6% vs 27.3%,P= .026; 2 hours: 0.0% vs 15.2%,P= .003). Patient satisfaction was significantly greater in group L than in group C (5.0 [IQR, 4.8-6.0] vs 4.0 [IQR, 4.0-5.0],P< .001). No lidocaine-related side effects were reported. Rescue medication-related side effects and surgical complications did not differ significantly between the 2 groups. CONCLUSIONS: Intravenous lidocaine administration resulted in lower incidence of moderate-to-severe CRBD, lower opioid requirement, and higher patient satisfaction in male patients undergoing TURBT without evidence of significant side effects.