本文由“罂粟花”授权转载
背景与目的
经尿道膀胱肿瘤电切术(TURBT)的男性患者易发生导管相关的膀胱不适(CRBD)。利多卡因已被广泛用于减轻术后疼痛。在此，我们评估了静脉注射利多卡因对接受TURBT男性患者的中重度CRBD的影响。
方法
随机分配患者接受利多卡因静脉注射（L组——1.5 mg/kg负荷剂量，术中持续输注2 mg/kg/h，术后持续1小时）或安慰剂（C组——生理盐水）。主要结果是术后0小时（转入麻醉恢复室）出现中重度CRBD，采用χ2检验进行分析。次要结果是术后24小时阿片类药物的用量。并评估术后1小时、2小时和6小时是否出现无CRBD、轻度和中重度CRBD，以及术后疼痛、患者满意度、利多卡因和抢救药物（曲马多和芬太尼）的副作用和手术并发症。
结果
本研究共纳入132例患者（每组66例）。术后0小时，L组中重度CRBD的发生率显著低于C组（25.8% vs66.7%，P 0.001，相对风险0.386，95%CI 0.248~0.602）。术后24小时，L组的阿片类药物用量明显低于C组（10.0 mg [IQR 5.0~15.0 mg]vs 13.8 mg[IQR 10.0~20.0 mg]，P=0.005）。术后1小时和2小时（术后6小时除外），L组中重度CRBD的发生率明显低于C组（1小时：10.6% vs27.3%，P=0.026；2小时：0.0% vs15.2%，P=0.003）。L组患者满意度明显高于C组（5.0[IQR 4.8~6.0] vs4.0[IQR 4.0~5.0]，P 0.001）。未发生利多卡因相关副作用。两组间抢救药物相关副作用及手术并发症无显著性差异。
结论
接受TURBT的男性患者，静脉注射利多卡因可降低中重度CRBD的发生率，减少阿片类药物用量，提高患者满意度，并且无明显副作用。
原始文献来源及摘要
KimDH,ParkJY,YuJ, et al. 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.[J].Anesth Analg ;131:220–7.
Abstract
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 χ2 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-evere CRBD, lower opioid requirement, and higher patient satisfaction in male patients undergoing TURBT without evidence of significant side effects.
静脉注射利多卡因预防男性患者经尿道膀胱肿瘤切除术后导管相关膀胱不适: 随机双盲对照试验
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