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。
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% vs 66.7%，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% vs 27.3%，P=0.026；2小时：0.0% vs 15.2%，P=0.003）。L组患者满意度明显高于C组（5.0[IQR 4.8~6.0] vs 4.0[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。
Kim DH, Park JY, Yu J, 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 2020;131:220–7.
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.
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