Comparison of intravenous lidocaine and dexmedetomidine infusion for prevention of postoperative catheter-related bladder discomfort: A randomized controlled trial

- Comparison of intravenous lidocaine and dexmedetomidine infusion for prevention of postoperative catheter-related bladder discomfort: a randomized controlled trial.
- Background: Catheter-related bladder discomfort (CRBD) frequently occurs during recovery in patients who undergo intra-operative urinary catheterization.
- We conducted this study to compare the effect of intravenous lidocaine and dexmedetomidine infusion for preventing CRBD..
- Methods: 120 patients undergoing elective open abdominal hysterectomy or hysteromyomectomy requiring urinary bladder catheterization were randomly allocated into three groups of 40 each.
- The incidence and different severity (mild, moderate, and severe) of CRBD were assessed on arrival in the postanaesthesia care unit at 0, 1, 2, and 6 h postoperatively..
- Results: The incidence of CRBD was significantly lower in Group L and Group D compared with Group C at 0, 1, and 2 h.
- However, there was no significant difference among the three groups regarding the different severity of CRBD at all time points.
- The requirement of rescue tramadol for CRBD was lower in group L and group D than in group C.
- The incidence of sedation was significantly higher in Group D compared to Group L and Group C, though no difference in other adverse effects was observed..
- Conclusions: Intravenous lidocaine and dexmedetomidine infusion reduced the incidence of CRBD as well as the additional tramadol requirement for CRBD, but had no effect on the different severity of CRBD..
- Keywords: Catheter-related bladder discomfort, Lidocaine, Dexmedetomidine.
- Urinary catheterization is widely used during surgery, and the incidence of postoperative catheter-related blad- der discomfort (CRBD) during recovery is as high as .
- The mechanism of CRBD is caused by involuntary contraction of the bladder, as mediated by muscarinic receptors, especially the subtype M 3 receptor [4].
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- Intravenous lidocaine infusion has analgesic and anti-inflammatory effects, reducing postoperative pain, nausea and vomiting, shortening hospital stay length, and promoting gastro- intestinal function recovery [19, 20].
- It is assumed that intravenous lidocaine has antimuscarinic properties [21]..
- We supposed that intravenous lidocaine infusion might be as useful as intravenous dexmedetomidine infusion for the prevention of CRBD.
- This study was designed to com- pare the effect of intravenous dexmedetomidine and lidocaine infusion for the prevention of CRBD and other adverse effects..
- After obtaining written informed consent from all pa- tients, we started this prospective, randomized, con- trolled, double-blind investigation.
- Patients with intra-operative damage to the urinary tract or intestinal tract, massive haemorrhage, or operative time >.
- The study drugs were stopped at the end of the surgery.
- At the end of the surgery, all patients received granisetron 3 mg and patient-controlled intravenous analgesia (PCIA) with sufentanil (0.5 μg/ml) and tramadol (4 mg/ml).
- Patients were transferred to the postanaesthesia care unit (PACU) after tracheal extubation for further recovery..
- Bladder discomfort and pain were assessed on arrival at the PACU (0 h) and again at 1, 2, and 6 h by an anesthesiologist who was unaware of the patient grouping..
- The severity of bladder discomfort was recorded as three grades: mild, re- vealed only on questioning.
- The sample size was estimated based on a preliminary experiment according to the incidence of CRBD in a range of 0.2 to 0.6 between three groups, with a = 0.05 and b = 0.10.
- 34 patients were needed in each group..
- The incidence and severity of CRBD, adverse effects, and additional tramadol requirements among the groups were assessed as percentage frequencies and tested by the chi-square test.
- 0.017 was considered significant among the three groups and P <.
- A total of 120 patients were recruited in this study.
- Four patients were withdrawn for massive haemorrhage (3 pa- tients) and intra-operative damage to the intestinal tract (1 patient).
- Ultimately, 116 patients (Group L = 39, Group D = 38, Group C = 39) were analyzed in this trial (Fig.
- intra-operative sufentanil use among the three groups (Table 1)..
- The incidence of CRBD was significantly lower in Group L compared to Group C at 0 h (P h (P = 0.021) and 2 h (P = 0.023).
- however, no difference between Group L and Group D was found.
- There was no sig- nificant difference among the three groups with re- spect to the different severity (mild, moderate, and severe) of CRBD at all time points (Table 2).
- The rescue tramadol requirement for CRBD was reduced in Group L (P = 0.02) and Group D (P = 0.012) compared to Group C, but there was no difference between Group L and Group D.
- Group D had a higher incidence of sedation than did Group L (P = 0.011) and Group C (P = 0.001).
- In this study, we found that intravenous lidocaine infu- sion was as effective as dexmedetomidine in reducing the incidence of CRBD and lessening the requirement of rescue tramadol..
- Thus, management of CRBD might be helpful in reducing postoperative emergence agitation, decreasing the work- load of medical staff and improving patient comfort..
- Table 1 Patients characteristics and clinical data among the three groups.
- Table 2 Incidence and severity of CRBD presented as numbers ( n.
- 0.05, There is significant difference between group D and group C..
- 0.05, There is significant difference between group L and group C.
- Consideration that the surgeries respected to the bladder or urethra can cause CRBD, in addition to the postoper- ative discomfort or pain originating from the surgical site, also seem to aggravate CRBD.
- In this investigation, patients undergoing open abdominal hysterectomy or hysteromyomectomy with the same-size catheter, we found a high incidence of CRBD up to 71.8%..
- Some studies have shown that dexmedetomidine decreases the incidence and sever- ity of CRBD.
- In our study, we found that dexmedetomidine reduced the incidence of CRBD as well as the additional tramadol re- quirement for CRBD but not the different severity (mild, moderate, and severe) of CRBD.
- Considering that dexmedetomidine was stopped at the end of the surgery, the postoperative sedative was higher in the dexmedetomidine group than in the other groups.
- The higher incidence of sedation might be also the reason for the low incidence of CRBD..
- Intravenous lidocaine infusion has been demonstrated to decrease intra-operative opioid requirements, reduce postoperative pain, nausea and vomiting, ameliorate post- operative ileus, shorten the length of hospital stay [19, 20]..
- In this study, we found that intravenous lidocaine infusion had the simi- lar effect of intravenous dexmedetomidine infusion on preventing of CRBD.
- There were some limitations in this study.
- Second, this study was limited to the period of the drug metabolism in the immediate postoperative period, and failed to address patient bladder discomfort beyond 6 h.
- Moreover, the severity of CRBD was recorded as three grades as mild, moderate, and severe which various descriptors were ap- plied to these levels.
- But, if we used visual analog scale (VAS) or verbal rating scale (VRS) to evaluate CRBD, the severity of CRBD might had significant difference among the three groups in this study.
- 2 Adverse effects among the three groups (presented as numbers).
- 0.05, There is significant difference between group L and group D.* P <.
- 0.05, There is significant difference between group D and group C.
- In conclusion, intravenous lidocaine and dexmedetomi- dine infusion reduced the incidence of CRBD as well as the additional rescue requirement for CRBD but not its different severity (mild, moderate, and severe) of CRBD in patients undergoing open abdominal hysterectomy or hysteromyomectomy..
- CRBD: Catheter related bladder discomfort.
- Predictors of catheter- related bladder discomfort in the postanaesthesia care unit.
- Management of catheter-related bladder discomfort in patients who underwent elective surgery.
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