Catheter-related bladder discomfort (CRBD) is a distressing symptom complex after surgery, especially in male patients who have had urinary catheterization under general anesthesia. In this prospective, randomized, controlled trial, we compared dorsal penile nerve block (DPNB) with 0.33% ropivacaine with intravenous tramadol 1.5 mg kg−1 in prevention of CRBD, as well as the incidences of postoperative side effects.Fifty-eight male patients aged 18 to 50 years, undergoing elective liver surgery and limb surgery with urinary catheterization, were enrolled and divided randomly into 2 groups. In the DPNB group, patients were given dorsal penile nerve block with 15 mL of 0.33% ropivacaine, and in the tramadol intravenous administration (TRAM) group, patients were given 1.5 mg kg−1 tramadol after the completion of surgery before extubation. The primary outcome was the incidence of CRBD, and the secondary outcomes included the severity of CRBD, postoperative side effects, postoperative pain, and the acceptance of urinary catheterization. Patients were evaluated upon arrival to postanesthetic care unit (PACU), at 0.5, 1, 2, 4, and 6 hours after patients’ arrival in the PACU for outcomes.The incidence of CRBD was significantly lower in the DPNB group than in the TRAM group, either upon arrival to PACU (10.3% vs 37.9%, P = 0.015), or at 0.5 hours (3.4% vs 34.5%, P = 0.003), 1 hours (3.4% vs 37.9%, P = 0.001), 2 hours (6.9% vs 34.5%, P = 0.010), and 4 hours (6.9% vs 27.6%, P = 0.039) after patients’ arrival in PACU. Compared with the TRAM group, the severity of postoperative CRBD upon arrival to PACU (P = 0.011) and at 0.5 hours (P = 0.005), 1 hours (P = 0.002), 2 hours (P = 0.005), 4 hours (P = 0.017), and 6 hours (P = 0.047) after patients’ arrival in PACU were all significantly reduced in the DPNB group. The incidences of postoperative nausea, vomiting, dizziness, and sedation were decreased significantly in the DPNB group compared with the TRAM group (P < 0.05). The acceptance of urinary catheterization was 93.1% (27/29 patients) in the DPNB group and 58.6% (17/29 patients) in the TRAM group, respectively (P < 0.001).DPNB with ropivacaine has a better effect for CRBD reduction and less side effects than intravenous tramadol administration.The trial has been registered at www.clinicaltrials.gov (NCT01721031).

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BackgroundDifficult airway has always been one of the greatest challenges for anesthesiologists. Patients with difficult airways and severe obstructive sleep apnea-hypopnea syndrome (OSAHS) often find themselves in life-threatening danger before their artificial airway is established and after their artificial airway is removed.Case presentationThe study reported a case of nasal polyps shedding into the tracheal tube when nasotracheal intubation in a patient diagnosed with a difficult airway and OSAHS; the patient was being prepared for a transoral tonsillectomy under general anesthesia. The uniqueness of this case was that nasal polyps were scraped off using the tracheal tube during nasotracheal intubation, and detected in real-time; this ultimately prevented an airway foreign body obstruction. Reviewing the literature on intubation methods for difficult airways, awake endotracheal intubation guided by fiberoptic bronchoscopy remains to be the gold standard for airway management. Additionally, nasotracheal intubation can provide more operating space for oral surgery. In this case, the unexpected nasal polyp fell off into the tracheal tube during intubation, as is visualized on the following pictures. This fortunate event prevented the nasal polyp from falling into the trachea and bronchus.ConclusionIt is necessary to rule out any nasal abnormalities in patients requiring nasotracheal intubation; otherwise, blind nasal intubation may be dangerous.