Dorsal Penile Nerve Block With Ropivacaine-Reduced Postoperative Catheter-Related Bladder Discomfort in Male Patients After Emergence of General Anesthesia

Abstract

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).

Efficacy of Unilateral Ilioinguinal Transversus Abdominis Plane Block for Alleviation of Catheter-related Bladder Discomfort in Male Patients after Emergence from General Anesthesia: a Prospective, Randomized Controlled Trial

“…Tramadol, which activates μ-opioid receptors and inhibits M1and M3 muscarinic receptors 20 , is also used to decrease the incidence and severity of CRBD 1,7,21 . However, as a rescue medication for severe CRBD, tramadol has a relatively slow onset and easily causes nausea and vomiting 20 .…”

“…With the rapid advancement of nerve blocks in recent years, the dorsal penile nerve block and pudendal nerve block have been demonstrated to be effective in decreasing the incidence and severity of CRBD 7,8 .…”

“…This may imply that the simple TAPB was incomplete. Speci cally, it did not block the dorsal penile nerve that covers the glans penis, and extradorsal penile nerve block may be considered as a supplemental therapy 7 . In addition, we found that unilateral ilioinguinal TAPB had a similar desired effect to that of bilateral ilioinguinal TAPB in the preliminary test (data not shown).…”

Strategies for the prevention of catheter-related bladder discomfort

“…[18] Although CRBD was defined as an urge to void or discomfort in the suprapubic region. The major characteristic of CRBD presented at the overactive bladder with the elevated symptoms of urinary frequency and urgency.…”

Efficacy of Unilateral Ilioinguinal Transversus Abdominis Plane Block for Alleviation of Catheter-related Bladder Discomfort in Male Patients after Emergence from General Anesthesia: a Prospective, Randomized Controlled Trial

“…With the rapid advancement of nerve block in recent years, dorsal penile nerve block and pudendal nerve block have been demonstrated to be effective in decreasing the incidence and severity of CRBD 7,8 . Moreover, efficacy of the transversus abdominis plane (TAP) block has been proven in various types of abdominal surgery 9 but reports that investigate the effects of TAPB in CRBD are unavailable.…”