Effects Of Intravenous Lidocaine On Bladder Spasm After Transurethral Resection Of Prostate

Objective:To observe the effect of perioperative intravenous injection of lidocaine on moderate to severe bladder spasm after transurethral resection of prostate under general anesthesia.Methods:（1）Grouping:The patients who planed to undergo transurethral resection of prostate under general anesthesia were selected according to the inclusion and exclusion criteria.The patients were divided into four groups by random number table,the control group（group C）,dexmedetomidine group（group D）,lidocaine group（group L）,lidocaine combined with dexmedetomidine group（group LD）,35 patients in each group.（2）Methods:The patients were interviewed one day before operation and their MMSE scores were recorded.On the day of surgery,group D received a bolus of 0.5μg/kg dexmedetomidine infusion 10 minutes before anesthesia induction,followed by an infusion of 0.4μg/kg·h dexmedetomidine until the end of the operation.Group L received a bolus of1.5 mg/kg lidocaine 10 minutes before anesthesia induction,followed by an infusion of 2mg/kg·h lidocaine until the end of the operation.Group LD received a bolus of 1.5 mg/kg lidocaine and 0.5μg/kg dexmedetomidine infusion 10 minutes before anesthesia induction,followed by an infusion of 2 mg/kg·h lidocaine and 0.4μg/kg·h dexmedetomidine until the end of the operation.Group C received a bolus and infusion of normal saline of equivalent volume.Heart rate（HR）and mean arterial pressure（MAP）were recorded at 5 min（T₀）,30min（T₁）after anesthesia,30 min（T₂）after operation and T₃after extubation.The incidence of moderate to severe bladder spasm at 24 h and 48 h after surgery,VAS score at 6 h,12 h,24 h and 48 h after surgery,the incidence of postoperative nausea and vomiting（PONV）at 1h,6 h and 24 h after operation were recored.Results:（1）There was no significant difference in HR between the four groups at T₀and T₃（P>0.05）.At T₁and T₂,HR in group D and LD were significantly lower than those in group C and L（P<0.05）.There was no significant difference in MAP of four groups at four time points（P>0.05）.（2）There was a statistically significant difference in the incidence of moderate to severe bladder spasm in the four groups at 24 h after surgery（P<0.05）.Compared with group C,the incidence of moderate to severe bladder spasm in patients in group D,L,and LD were reduced,and the difference was statistically significant（P<0.05）;compared with group D,the incidence of moderate to severe bladder spasm in group L and group LD were significantly lower（P<0.05）;there was no significant difference in the incidence of moderate to severe bladder spasm between group L and group LD（P>0.05）.There was no statistically significant difference in the incidence of moderate to severe bladder spasm in the four groups at 48 hours after surgery（P>0.05）.（3）There were significant differences in VAS scores at 6 h,12 h,24 h and 48 h after operation among the four groups（P<0.05）.Compared with group C,the VAS scores of group D,group L and group LD were lower at 6 h,12 h,24 h and 48 h after operation,the difference was statistically significant（P<0.05）;the VAS scores of group LD at four time points were lower than the other three groups,the difference was statistically significant（P<0.05）;compared with group D,the VAS scores of group L at four time points were lower,but the difference was statistically significant only at 12 h and 24 h after operation（P<0.05）.（4）There was no statistically significant difference in the preoperative MMSE scores of the four groups of patients（P>0.05）.Compared with group C,patients in group D,L,and LD had higher MMSE scores at 1 and 3 days after surgery,and the difference was statistically significant（P<0.05）;compared with group L,the MMSE scores of group D were higher on postoperative 1st and 3rd days（P<0.05）;compared with group L,the MMSE scores of the patients in the group LD did not increase significantly on the 1st and 3rd day after surgery,and the difference was not statistically significant.（P>0.05）.（5）Compared with group C,group D and group L,the incidence of PONV in group LD at 1 h,6 h and 24 h after operation were significantly lower（P<0.05）;compared with group C,the incidence of PONV in group D and group L was significantly lower at 1 h and 6h after operation（P<0.05）.There was no significant difference in the incidence of PONV between group D and group L at three time points（P>0.05）.Conclusion:（1）Perioperative intravenous injection of lidocaine and dexmedetomidine can reduce the incidence of moderate to severe bladder spasm 24 hours after TURP,while the effect of lidocaine is more significant,but the effect of combination of lidocaine and dexmedetomi-dine is not significantly enhanced.（2）Perioperative intravenous injection of lidocaine and dexmedetomidine can reduce postoperative pain,and the analgesic effect of the combination of lidocaine and dexmedetomidine is more significant.（3）Perioperative intravenous lidocaine and dexmedetomidine can increase the MMSE score and reduce the incidence of postoperative delirium,but dexmedetomidine is more effective.（4）Perioperative intravenous injection of lidocaine and dexmedetomidine can reduce the incidence of PONV within 6 hours after operation,and the effect of the combination of lidocaine and dexmedetomidine is more significant.