Occurrence and Severity of Catheter-Related Bladder Discomfort of General Anesthesia Plus Epidural Anesthesia vs. General Anesthesia in Abdominal Operation With Urinary Catheterization: A Randomized, Controlled Study.

Shunxiang Sun,Jun Zhang,Pengfei Sun,Cheng Wang

doi:10.3389/fsurg.2021.658598

Abstract

Background: This randomized, controlled study aimed to investigate the effect of general anesthesia plus epidural anesthesia on catheter-related bladder discomfort (CRBD) in patients who underwent abdominal operation with urinary catheterization.Methods: A total of 150 patients scheduled for abdominal operation under anesthesia with urinary catheterization were randomized to receive general anesthesia plus epidural anesthesia (N = 74, GA + EA group) or general anesthesia (N = 76, GA group). The occurrence and severity of CRBD, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded at 0 hour (h), 0.5, 1, and 3 h after tracheal extubation. Besides, postoperative adverse events were assessed.Results: The occurrence and severity of CRBD at 0, 0.5, 1, and 3 h were all reduced in GA + EA group compared to GA group (all P < 0.05). Meanwhile, subgroup analyses showed that the reduction of occurrence and severity of CRBD in GA + EA group compared to GA group was more obvious in male patients and patients ≥50 years. Besides, SBP at 0, 0.5, 1, and 3 h, as well as DBP at 0, 0.5, and 3 h were all decreased in GA + EA group compared to GA group (all P < 0.05), while HR was increased at 0 h in GA + EA group compared to GA group (P = 0.034). Moreover, the occurrence of pain, severity of pain and occurrence of vomiting were similar between GA + EA group and GA group (all P > 0.05).Conclusion: General anesthesia plus epidural anesthesia decreases CRBD occurrence and severity with tolerable safety compared with general anesthesia in patients who undergo abdominal operation with urinary catheterization.

Highlights

Subgroup analyses showed that the reduction of occurrence and severity of catheter-related bladder discomfort (CRBD) in GA + EA group compared to GA group was more obvious in male patients and patients ≥50 years
systolic blood pressure (SBP) at 0, 0.5, 1, and 3 h, as well as diastolic blood pressure (DBP) at 0, 0.5, and 3 h were all decreased in GA + EA group compared to GA group, while heart rate (HR) was increased at 0 h in GA + EA group compared to GA group (P = 0.034)
General anesthesia plus epidural anesthesia decreases CRBD occurrence and severity with tolerable safety compared with general anesthesia in patients who undergo abdominal operation with urinary catheterization

Summary

Introduction

Urinary catheterization is vastly performed during various abdominal operations, while it might lead to several adverse events including urinary tract infection and catheter-related bladder discomfort (CRBD) [1, 2]. Epidural anesthesia is proved to provide a good anesthetic effect with acceptable tolerance [9] It possesses potential regulation on urinary tract function: previous studies suggest that epidural anesthesia reduces bladder sensitivity and decreases the urge to void possibly by inhibiting detrusor activity and bladder contraction, and the latter ones are partly regulated by the sympathetic fiber in the intermediolateral cell column of the spinal cord (T11-L2) [10,11,12,13]. Since the CRBD is mechanically similar to the overreactive bladder caused by bladder involuntary contraction [14], we hypothesized the general anesthesia plus epidural anesthesia might reduce the occurrence of CRBD with good tolerance compared to general anesthesia in patients who underwent abdominal operation with urinary catheterization. This randomized, controlled study aimed to investigate the effect of general anesthesia plus epidural anesthesia on catheter-related bladder discomfort (CRBD) in patients who underwent abdominal operation with urinary catheterization

Methods

Results

Discussion

Conclusion