Spinal Anesthesia Provides Longer Administration Time for Postoperative Intravesical Chemotherapy after TUR-B Operation

2021 ◽  
pp. 1-7
Author(s):  
Nusret Can Çilesiz ◽  
Arif Özkan ◽  
Arif Kalkanlı ◽  
Cem Tuğrul Gezmiş ◽  
Gökhan Yazıcı ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Urine Volume ◽  
Intravesical Chemotherapy ◽  
T Stage ◽  
Removal Time ◽  
Size Number ◽  
Tumor Number ◽  
Administration Time ◽  
Vas Scores ◽  
Stratification System

<b><i>Purpose:</i></b> The aim of this study was to investigate the tolerability of postoperative early intravesical chemotherapy session after transurethral resection of the bladder tumor (TUR-B) according to the different anesthesia types. <b><i>Methods:</i></b> The study was conducted between February 2017 and June 2020. Patients who were given intravesical mitomycin (MMC) 40 mg after TUR-B were included. Patients’ risk categories (low, medium, and high) were determined according to the European Association of Urology (EAU) risk stratification system based on the tumor number, size (&#x3c;3 and ≥3 cm), T stage (Ta and T1), and grade (low and high). Patients were divided into 2 groups according to the applied anesthesia technique as group S (spinal) and group G (general). The patients’ visual analog scale (VAS) scores were recorded every 30 min for 2 h after urethral clamping. The patients’ pain scores were recorded using the VAS questionnaire form at 30th (VAS1), 60th (VAS2), 90th (VAS3), and 120th (VAS4) min after the urethral clamping. Requirement of analgesic, urethral clamp removal time, total instillation time, and discharged urine volume were recorded. Complications and complication grade (1–5) were recorded according to the Clavien-Dindo system. <b><i>Results:</i></b> A total of 232 consecutive patients who received intravesical MMC were included. Sociodemographic characteristics of group S (<i>n</i> = 113) and group G (<i>n</i> = 119) were similar (<i>p</i> &#x3c; 0.05). There were no significant differences in tumor size, number of tumors, concomitant CIS, and T stage in both groups (<i>p</i> &#x3e; 0.05). High-grade tumors were higher in group S (23.9 vs. 11%; <i>p</i> = 0.008). Requirement of analgesic (53.9 vs. 91.5%; <i>p</i> = 0.00) and termination of therapy &#x3c;60′ (2 vs. 26%; <i>p</i> = 0.00) and &#x3c;120′ (32.7 vs. 76.4%; <i>p</i> = 0.00) were significantly lower in group S. The mean instillation time (108.05 ± 19.40 vs. 85.67 ± 24.66 min; <i>p</i> = 0.00) was found significantly higher for group S. In group G, mean VAS1–4 scores were significantly higher than in group S (<i>p</i> &#x3c; 0.05). Linear correlation analyses showed that the VAS score is correlated with the instillation time (<i>p</i> &#x3c; 0.05). The rates of minor (I–III) (7 vs. 8%; <i>p</i> = 0.706) and major (IV–V) (0.9 vs. 1.6%; <i>p</i> = 0.590) complications were similar in both groups. <b><i>Conclusion:</i></b> The patients’ tolerability of intravesical MMC treatment can be improved by spinal anesthesia. It provides longer instillation time and less pain during intravesical chemotherapy.

scholarly journals Electroacupuncture for Bladder Function Recovery in Patients Undergoing Spinal Anesthesia

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Yinqiu Gao ◽  
Xinyao Zhou ◽  
Xichen Dong ◽  
Qing Jia ◽  
Shen Xie ◽  
...  
Keyword(s):  
Adverse Events ◽  
Spinal Anesthesia ◽  
Urinary Retention ◽  
Urine Volume ◽  
Bladder Function ◽  
Control Group ◽  
Postoperative Urinary Retention ◽  
Function Recovery ◽  
Significant Difference ◽  
Secondary Endpoints

Purpose. To determine the efficacy of electroacupuncture on recovering postanesthetic bladder function.Materials and Methods. Sixty-one patients undergoing spinal anaesthesia were recruited and allocated into electroacupuncture or control group randomly. Patients in electroacupuncture group received electroacupuncture therapy whereas ones in control group were not given any intervention. Primary endpoint was incidence of bladder overdistension and postoperative urinary retention. Secondary endpoints included time to spontaneous micturition, voided volume, and adverse events.Results. All patients (31 in electroacupuncture group and 30 in control group) completed the evaluation. During postoperative follow-up, patients in electroacupuncture group presented a significant lower proportion of bladder overdistension than counterparts in control group (16.1% versus 53.3%,P< 0.01). However, no significant difference was found in incidence of postoperative urinary retention between the two groups (0% versus 6.7%,P> 0.05). Furthermore, a shorter time to spontaneous micturition was found in electroacupuncture group compared to control group (228 min versus 313 min,P< 0.001), whereas urine volume and adverse events had no significant difference between the two groups.Conclusions. Electroacupuncture reduced the proportion of bladder overdistension and shortened the time to spontaneous micturition in patients undergoing spinal anesthesia. Electroacupuncture may be a therapeutic strategy for postanesthetic bladder dysfunction.

scholarly journals Does wound infi ltration of tramadol reduce postoperative pain in laparoscopic or open herniorrhaphy?

2012 ◽  
Vol 2 (2) ◽  
pp. 127-131
Author(s):  
Remziye Sıvacı ◽  
Erol Eroglu ◽  
Lutfi Yavuz ◽  
Fusun Eroglu ◽  
Yaşar Sıvacı
Keyword(s):  
Postoperative Pain ◽  
Spinal Anesthesia ◽  
Wound Closure ◽  
Saline Solution ◽  
Laparoscopic Approach ◽  
Analog Scale ◽  
Inguinal Herniorrhaphy ◽  
Vas Scores ◽  
Laparoscopic Inguinal Herniorrhaphy ◽  
Open Inguinal Herniorrhaphy

Introduction: The laparoscopic approach may be associated with more postoperative pain initially. The aim of this study was to evaluate the effects of administered tramadol at wound closure on postoperative painand analgesic requirements under spinal anesthesia in laparoscopic inguinal herniorrhaphy (LH) or tension free open inguinal herniorrhaphy (TFOH).Methods: Twenty patients were randomly divided into two groups (n= 10 in each) as LH or TFOH. Patients received infiltration of 200 mg tramadol with 40 mL of 0.9% saline solution at wound closure procedure. Postoperative pain was assessed with a Visual Analog Scale (VAS) at 3, 6, 12, and 24 hours postoperatively. Additional requirements of tramadol for postoperative pain releif were registered.Results: VAS scores at postoperative 12 and 24 hours were signifi cantly higher according to 3rd hour VAS scores in both groups. The VAS scores at 12 hours after operation signifi cantly lower in LH group than inTFOH group (1.5 ± 0.97 vs 5.1 ± 0.99). Additional requirements of tramadol for postoperative pain releif were significantly lower in LH group.Conclusion: We conclude that wound infi ltration of 200 mg tramadol reduce postoperative pain in LH group.

scholarly journals Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

2015 ◽  
Vol 133 (3) ◽  
pp. 227-234 ◽  
Author(s):  
Anıl İçel Saygı ◽  
Özkan Özdamar ◽  
İsmet Gün ◽  
Hakan Emirkadı ◽  
Ercüment Müngen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Urine Volume ◽  
Fetal Distress ◽  
Controlled Clinical Trial ◽  
Fetal Outcomes ◽  
General Anesthesia Group

CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital.METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.RESULTS: Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group.CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

scholarly journals Spinal Anesthesia and Spinal Anesthesia with Subdiaphragmatic Lidocaine in Shoulder Pain Reduction for Gynecological Laparoscopic Surgery: A Randomized Clinical Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Zahra Asgari ◽  
Mahroo Rezaeinejad ◽  
Reihaneh Hosseini ◽  
Masoumeh Nataj ◽  
Maryam Razavi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Surgery ◽  
Spinal Anesthesia ◽  
Primary Outcome ◽  
Pain Perception ◽  
Pain Reduction ◽  
Time Interval ◽  
Significant Difference ◽  
Gynecological Surgical Procedures ◽  
Vas Scores

Objective. The aim of this study was to compare the effectiveness of spinal anesthesia with subdiaphragmatic lidocaine at the beginning of surgery versus spinal anesthesia in pain reduction for gynecological laparoscopic surgery. Methods. This was a clinical trial conducted in Arash Hospital, Tehran, Iran. Eighty-four patients were randomized to either spinal anesthesia with subdiaphragmatic lidocaine, spinal anesthesia, or general anesthesia (GA). The primary outcome was patients’ pain perception during surgery, 2, 4, 6, and 12 hours after surgery, and prior to discharge and was assessed by visual analogue scale (VAS). Results. The results showed that there are no significant changes in pain perception over time in none of the three groups (F(4,76) = 0.37, P=0.82). The severity of pain experienced by patients at all-time interval after surgery was similar between groups [F(2,79) = 0.54, P=0.58]. Conclusion. The use of subdiaphragmatic lidocaine at the beginning of surgery combined with spinal anesthesia was not associated with a statistically significant difference in patients’ postoperative VAS scores compared to spinal anesthesia and GA during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial by the number of IRCT2016022226698N1.

scholarly journals Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Jinguo Wang ◽  
Hongqin Li ◽  
Haichun Ma ◽  
Na Wang
Keyword(s):  
Spinal Anesthesia ◽  
Transurethral Resection ◽  
Control Group ◽  
Prospective Clinical Study ◽  
Analgesic Requirement ◽  
Flurbiprofen Axetil ◽  
Analgesic Consumption ◽  
Postoperative Time ◽  
Vas Scores ◽  
Group Control Group

Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

scholarly journals Effect of IV Infusion of Magnesium Sulfate on Postoperative Pain after Spinal Anesthesia: A Prospective Randomized Trial

2021 ◽  
Author(s):  
Shubhi Singhal ◽  
Devang Bharti ◽  
Sangeeta Yadav ◽  
Nitin Hayaran
Keyword(s):  
Postoperative Pain ◽  
Magnesium Sulfate ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Controlled Study ◽  
Control Group ◽  
Analgesic Requirement ◽  
Group I ◽  
Significant Difference ◽  
Vas Scores

Background: The current study attempts to evaluate the effect of intravenous (IV) infusion of magnesium sulfate during spinal anesthesia on postoperative pain and postoperative analgesic requirements in lower limb surgeries. Methods: In this double blind, randomized controlled study, 60 patients undergoing elective lower limb surgeries, were selected and randomly divided into two groups. Group I received isotonic saline and group II was administered magnesium sulfate 50 mg Kg-1 IV for 15 min and then 15 mg Kg-1 h-1 by continuous IV infusion till the end of surgery or 2 hours, whichever was earlier. Ramsay sedation scores, VAS scores for pain, time of first administration of rescue analgesic and total analgesic requirement were noted in both the groups. Results: Statistically significant difference was observed in the VAS score between the two groups at 1st, 2nd, 3rd, 6th, 9th and 12th hour intervals; with VAS scores being lower in the magnesium group (p<0.05). The mean time of first rescue analgesic requirement in control group was 144.00 mins, while in magnesium group was 246.00 mins (p<0.05). The total rescue analgesic requirement was found to be 251.67 mg and 181.67 mg at the end of 24 hours, in control and magnesium groups, respectively (p<0.05). Conclusion: This study demonstrates statistically significant lowering of postoperative VAS scores, delayed need of postoperative analgesia and reduced total postoperative analgesic requirement in patients receiving intraoperative IV magnesium sulfate compared to the control group. Magnesium sulfate did not cause sedation or any other significant adverse effect in the doses used in the study.

scholarly journals Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up

2018 ◽  
Vol 90 (1) ◽  
pp. 11 ◽  
Author(s):  
Vittorio Imperatore ◽  
Massimiliano Creta ◽  
Sergio Di Meo ◽  
Roberto Buonopane ◽  
Nicola Longo ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Urine Volume ◽  
Urinary Urgency ◽  
Bacillus Calmette Guerin ◽  
First Line ◽  
Bladder Pain ◽  
Vas Scores ◽  
One Year ◽  
Intravesical Instillations

Objective: We investigated the efficacy of intravesical instillations of combined hyaluronic acid (HA) and chondroitin sulphate (CS) in patients with bacillus Calmette-Guérin (BCG)-induced chemical cystitis unresponsive to first-line therapies. Patients and methods: We retrospectively reviewed the clinical records of patients with grade 2 BCG-induced chemical cystitis unresponsive to first line therapeutic options performed according to the International Bladder Cancer Group guidelines who underwent intravesical instillations of HA/CS. Bladder pain, urinary urgency, voiding volume and number of voids/24 hours recorded prior to treatment, at the end of the treatment, at six months and at one-year follow-up were recorded and analyzed. Results: The records of 20 patients were identified. All patients underwent eight weekly instillations of HA/CS. Mean baseline visual analogue scale (VAS) scores ± Standard Deviation (SD) for urinary urgency and bladder pain were 7.8 ± 0.5 and 7.2 ± 1.0, respectively. Mean number of voids/24 hours ± SD was 15.4 ± 2.3 and mean urine volume per void ± SD was 85.8 ± 21.0 mL. At the end of the treatment, mean VAS scores ± SD for urgency and pain significantly decreased to 4.7 ± 1.1 and 4.2 ± 0.9, respectively (p < 0.05 in both cases). Mean number of voids/24 hours ± SD decreased to 9.6 ± 1.4 (p < 0.05) and mean urine volume per void ± SD significantly increased to 194.1 ± 59.5 mL (p < 0.05). At six months and one-year followup, all outcome measures remained stable. Conclusions: Bladder instillations of HA/CS provide significant and durable improvement of bladder pain, urinary urgency, urinary volume per void and urinary frequency in patients with refractory BCG-induced chemical cystitis.

Recovery of Storage and Emptying Functions of the Urinary Bladder after Spinal Anesthesia with Lidocaine and with Bupivacaine in Men 

1998 ◽  
Vol 88 (2) ◽  
pp. 310-316 ◽  
Author(s):  
Ed T. Kamphuis ◽  
Trian I. Ionescu ◽  
Peter W. G. Kuipers ◽  
Jos de Gier ◽  
Ger E. P. M. van Venrooij ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Spinal Anesthesia ◽  
Local Anesthetics ◽  
Urine Volume ◽  
Bladder Capacity ◽  
Bladder Function ◽  
Motor Blockade ◽  
Lidocaine Group ◽  
The Third ◽  
Sacral Segment

Background The aim of this study was to evaluate and compare the effects of spinal anesthesia with lidocaine and with bupivacaine on urinary bladder function in healthy men who were scheduled for minor orthopaedic surgical procedures. Methods Twenty men were randomly allocated to receive either bupivacaine or lidocaine. Before spinal anesthesia, filling cystometry was performed with the patient in the supine position and a pressure flow study was done with the patient in the standing position. After operation, cystometric measurements were continued until the patient could void urine spontaneously. The levels of analgesia and of motor blockade were recorded. Results The urge to void disappeared immediately after injection of the local anesthetics. There was no difference in the duration of lower extremity motor blockade between bupivacaine and lidocaine. Detrusor blockade lasted significantly longer in the bupivacaine group (means +/- SD, 460 +/- 60 min) than in the lidocaine group (235 +/- 30 min). Total fluid intake and urine volume accumulated during the detrusor blockade were significantly higher in the bupivacaine group than in the lidocaine group. In the bupivacaine group, the total volume of accumulated urine (875 +/- 385 ml) was also significantly higher than cystometric bladder capacity (505 +/- 120 ml) with the risk of over distension of the bladder. Spontaneous voiding of urine did not occur until segmental sensory analgesia had regressed to the third sacral segment. Conclusions Spinal anesthesia with lidocaine and with bupivacaine causes a clinically significant disturbance of bladder function due to interruption of the micturition reflex. The urge to void disappears quickly and bladder function remains impaired until the block has regressed to the third sacral segment in all patients. With long-acting local anesthetics, the volume of accumulated urine may exceed the cystometric bladder capacity. With respect to recovery of urinary bladder function, the use of short-acting local anesthetics for spinal anesthesia seems to be preferable.

scholarly journals The Effect of ShotBlocker on Pain and Patient Satisfaction for Spinal Anesthesia: A Randomized Trial

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. E31-E36
Keyword(s):  
Patient Satisfaction ◽  
Randomized Trial ◽  
Spinal Anesthesia ◽  
Involuntary Movement ◽  
University Hospital ◽  
Injection Pain ◽  
Control Group ◽  
Unintentional Movement ◽  
Significant Difference ◽  
Vas Scores

BACKGROUND: During spinal anesthesia, patients may experience pain and discomfort associated with dermal puncture. It may also cause involuntary movement, which often disturbs the patient’s posture thus affecting the success of spinal anesthesia. Different methods have been studied to cope with needle-related pain. “ShotBlocker” is a flexible, plastic, U-shaped device, which has several blunt points. It is suggested that blunt points provide a nonnoxious physical stimulation and inhibit the transmission of injection pain. OBJECTIVES: The purpose of this study was to examine the effectiveness of the ShotBlocker for dermal puncture pain during spinal anesthesia. STUDY DESIGN: Prospective randomized trial. SETTING: University hospital, operating room. METHODS: Ninety-four patients aged 18 to 65 years with physical status American Society of Anesthesiologists (ASA) I or II scheduled for elective surgery under spinal anesthesia were randomly assigned to either a ShotBlocker (n = 47) or control group (n = 47). In the ShotBlocker group, lumbar punctures were performed with the application of ShotBlocker. Needle-associated pain score and patient satisfaction were assessed by the patient, immediately after completion of the spinal anesthesia using a 10-cm Visual Analog Scale (VAS) and a 5-point Likert scale for satisfaction. Patients were also closely observed for symptoms of discomfort such as spontaneous vocalization and involuntary movement. RESULTS: A total of 88 patients completed the study. There was no significant difference in VAS scores, patient satisfaction, or procedure time between groups (P > 0.05). Spontaneous vocalization did not occur in both groups. However, incidence of unintentional movement during dermal puncture was higher in the control group (6.8% vs. 31.8%; P < 0.05). LIMITATIONS: Study was conducted in a single-center with a relatively small population of patients. Only the attending anesthetist collecting data was blinded to the procedure. Patients older than age 65 years were also excluded from the study, thus our results cannot be generalized. CONCLUSIONS: ShotBlocker did not show any advantage on VAS scores but decreased the incidence of unintentional movement during dermal puncture. KEY WORDS: Spinal anesthesia, pain, ShotBlocker, needle, pin-prick pain, dermal puncture, neuraxial block, regional, needle phobia, lumbar puncture

scholarly journals The Effect of Intravenous Magnesium Sulfate Infusion on Sensory Spinal Block and Postoperative Pain Score in Abdominal Hysterectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Fatih Kahraman ◽  
Ahmet Eroglu
Keyword(s):  
Postoperative Pain ◽  
Spinal Anesthesia ◽  
Magnesium Sulphate ◽  
Abdominal Hysterectomy ◽  
Control Group ◽  
Spinal Block ◽  
Double Blind ◽  
Arterial Blood ◽  
Vas Scores ◽  
And Control

Aim. The aim of this study was to investigate the effect of i.v. infusion of magnesium sulphate during spinal anesthesia on duration of spinal block and postoperative pain.Methods. Forty ASA physical status I and status II, aged between 18 and 65, female patients undergoing abdominal hysterectomy under spinal anesthesia were enrolled in this study. Patients in the magnesium group (Group M,n= 20) received magnesium sulphate 65 mg kg−1infusion in 250 mL 5% dextrose at 3.5 mL/min rate, and control group (Group C,n= 20) received at the same volume of saline during operation in a double-blind randomized manner. Duration of sensory and motor block, systolic, diastolic, and mean arterial blood pressures, heart rates, pain scores (VAS values), and side effects were recorded for each patient. Blood and CSF samples were taken for analysis of magnesium concentrations.Results. Regression of sensorial block was longer in Group M when compared with that in Group C (175 ± 39 versus 136 ± 32 min) (P< 0.01). The VAS scores were lower in Group M than those in Group C at the 2 time points postoperatively (P< 0.01).Conclusion. 65 mg kg−1of magnesium sulphate i.v. infusion under spinal anesthesia prolongs spinal sensorial block duration and decreases pain VAS scores without complication in patients undergoing abdominal hysterectomy.

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