A randomised‐controlled, prospective study on the effect of dorsal penile nerve block after TURP on catheter‐related bladder discomfort and pain

Abstract

In the present study, the impact of penile nerve block (PNB) on postoperative pain and Catheter-Related Bladder Discomfort (CRBD) in the transurethral resection of prostate(TURP) patients were evaluated. Methods:Participants of the present study were selected from patients who performed TURP under spinal anaesthesia for benign prostatic hyperplasia (BPH) between January 2018 and July 2020. The present study was planned as a single-centre, randomised-controlled prospective study in which the patients were divided into two groups. Group 1 was administered Control (n:40), and Group 2 ultrasonography(USG) guided PNB (n:40). The patients were included in the Groups, respectively. Visual analogue scale (VAS) scores were questioned and recorded in order to evaluate the postoperative pain complaints of the patients after the operation. In addition, in order to evaluate the CRBD, VAS scores were questioned and recorded as 0th, 0-1th hour, 1st-2nd hour, 2nd-4th hour, 4th-8th hour, 8th-12th hour, and 12th-24th hour.In addition, postoperative pain and need for analgesic drug were recorded. Tramadol was given to patients with moderate to severe CRBD. The findings were compared between the Groups.Results: There was no statistical difference demographic and per-operative data between Group 1 and Group 2. The CRBD and pain-related VAS scores were significantly higher in Group 1 between the 0 and 8th hours. There was no difference between VAS scores in the postoperative 8-24th hours. In total 24 hours, Group 2's need for tramadol was significantly less than Group 1. On examining the factors affecting CRBD in the multivariate analysis, age, body mass index(BMI), prostate volume, operation time do not affect CRBD statistically, and only PNB reduces CRBD (P: .029). While less drug-related complications were observed in Group 2, no serious complications related to PNB were observed. Conclusion:Penile nerve block is an effective method for the decrease pain and CRBD after urological surgery. It will also reduce the need for analgesics, and provide painless patients in the postoperative period. How to cite this article: Göger YE, Özkent MS, Göger E, et al. A randomised-controlled, prospective study on the effect of dorsal penile nerve block after TURP on catheter-related bladder discomfort and pain.

Effect of Pudendal Nerve Block on the Prevention of Postoperative Bladder Spasm and Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Holmium Laser Enucleation of the Prostate

“…The dose of ropivacaine was determined based on previous studies. 9 The local anesthetic spread in a fusiform pattern between the sacrospinous ligament, the sacrotuberous ligament, and the internal pudendal artery. After unilateral block, the position of the patient was changed to block the contralateral side using the same ultrasound-guided technology.…”

“… 4 Some severe patients require transfusion or reoperation to stop hemorrhage. Patients experience more CRBD after urological surgery than other surgery, with an incidence of 47–90%, 9 and they are more prone to moderate-to-severe CRBD. CRBD is defined as urinary urgency and urethral pain.…”

“…Indwelling catheter and bladder irrigation excite the stretch receptors, which leads to BS and CRBD. Various regional block modalities have been used for CRBD, such as spinal anesthesia, 14 epidural anesthesia, 15 dorsal penile nerve block, 9 and bladder flushing with bupivacaine. 16 Intrathecal bupivacaine and morphine 8 are also effective in reducing BS, suggesting that blocking sensory nerves in the urethra and bladder may prevent BS and CRBD.…”

“…Our study demonstrated a significantly lower incidence of BS and a shorter irrigation time, similar to the conclusion of this We also found that after PNB, postoperative CRBD was significantly reduced and less severe, and the catheter acceptance was high. The PN is the main nerve that innervates the perineum, and the dorsal nerve of the penis, which is a branch of the PN, innervates the membranous urethra, 9 which may reduce urethral stimulation by the catheter. In a study conducted in 2017, nerve stimulator-guided transperineal PNB with the sciatic spine as a marker decreased both the incidence (64% vs 90%) and intensity of CRBD and reduced postoperative pain after trans-urethral resection of prostate and trans-urethral resection of bladder tumor.…”

Safety and efficacy of wrist-ankle acupuncture in treating catheter-related bladder discomfort after transurethral resection of the prostate: a double-blind randomized clinical trial

“…Patients may experience agitation characterized by flailing limbs, strong verbal responses, and attempts to pull out the catheter during recovery. All of the above symptoms constitute catheter-related bladder discomfort (CRBD) ( 3 - 5 ). Surgical injury due to both qi and blood deficiency, qi stagnation and blood stasis, hot and humid disturbance, combined with indwelling catheter to stimulate urethral mucosa aggravate bladder discomfort related symptoms.…”