Effects Of Different Doses Of Lidocaine On The Prevention And Treatment Of Catheter-related Bladder Discomfort After Ureteroscopic Lithotripsy

Objective:To compare the safety and efficacy of intravenous infusion of different doses of lidocaine in the prevention and treatment of catheter-related bladder discomfort after ureteroscopic lithotripsy.Methods:Between August 2022 and February 2023,a total of 120 male patients aged18 to 70 years,with a BMI of 18-30 kg/m~2 and ASA I-II classification,underwent ureteroscopic lithotripsy under general anesthesia.The patients were randomly assigned to one of four groups:a control group(group C),lidocaine group 1(group L1),lidocaine group 2(group L2),and lidocaine group 3(group L3),with 30 cases in each group.The study administered lidocaine to three groups of patients,labeled L1,L2,and L3,ten minutes prior to the induction of general anesthesia.The L1 group received a loading dose of 1.0mg/kg of lidocaine,followed by an infusion of 1.0mg/(kg·h)until the end of the operation.The L2 group received a loading dose of 1.5mg/kg of lidocaine,followed by an infusion of 1.5mg/(kg·h)until the end of the operation.The L3 group received a loading dose of 2.0mg/kg of lidocaine,followed by an infusion of 2.0mg/(kg·h)until the end of the operation.A control group received an equal volume of normal saline both before and during the surgery.In this study,patients in all four groups were given anesthesia induction drugs such as midazolam,etomidate,sufentanil,and cisatracurium.Total intravenous anesthesia was used for maintenance,which was adjusted based on monitoring indicators like mean arterial pressure and heart rate.The anesthesia dosage was maintained to ensure hemodynamic stability,and the BIS was kept between 40-60.The anesthesia maintenance drug infusion was stopped 5 minutes before the end of the operation.After waking up,patients had their laryngeal mask removed and were observed in the PACU.General information,including age,weight,height,BMI,operation time,anesthesia time,and recovery time,was recorded for all four groups of patients.This study aimed to record the MAP and HR of four groups of patients at different time points,including room entry(T0),immediately after entering the PACU(T1),30 minutes(T2),1 hour(T3),and 2 hours(T4).Additionally,postoperative conditions were recorded,such as the occurrence of CRBD,Ramsay sedation score,and urethral pain VAS score.Restlessness in the PACU was also noted.The use of tramadol and adverse reactions were recorded for all four groups of patients.Statistical analysis was performed using SPSS 26.0 software,and a P-value of less than 0.05 was considered statistically significant.Results:Finally,a total of 108 patients were included in the study.(1)General data of the four groups of patients did not show any statistical significance(P>0.05).(2)At T0 time point,there was no significant difference in MAP and HR between the four groups(P>0.05).However,at T1,T2,and T3 time points,the MAP and HR of group L1,L2,and L3 were significantly lower compared to group C(P<0.05).At T4 time point,the MAP of group L2 and L3 were significantly lower compared to group C(P<0.05).Additionally,the HR of group L1,L2,and L3 were significantly lower compared to group C(P<0.05)at T4 time point.(3)The incidence of CRBD was significantly lower in group L1,L2,and L3compared to group C at time points T1,T2,T3,and T4(P<0.05).Furthermore,the incidence of CRBD was significantly lower in group L2 and L3 compared to group L1at time points T2,T3,and T4(P<0.05).Patients in groups L2 and L3 had a significantly lower incidence of moderate to severe CRBD compared to group C at time points T1,T2,and T3(P<0.05).Additionally,the incidence of moderate to severe CRBD was significantly lower in groups L2 and L3 compared to group L1 at time points T1 and T2(P<0.05).(4)In comparison to group C,groups L1,L2,and L3 showed a statistically significant increase in Ramsay sedation scores at T1(P<0.05).Additionally,groups L1,L2,and L3 exhibited a statistically significant decrease in VAS score of urethral pain at T1,T2,T3,and T4(P<0.05).Furthermore,the incidence of agitation in PACU was significantly lower in groups L2 and L3 compared to group C(P<0.05).(5)Compared to group C,groups L2 and L3 showed a statistically significant decrease in postoperative salvage drug tramadol cases(P<0.05).However,there was no significant difference in the incidence of postoperative nausea and vomiting among all four groups(P>0.05).Patients in groups L1,L2,and L3 did not experience any adverse reactions of lidocaine such as dizziness,tinnitus,numbness of lips and tongue around the mouth,convulsions,and delay in awakening.Conclusion:(1)In male patients undergoing ureteroscopic lithotripsy,intravenous infusion of lidocaine has been found to reduce the incidence of CRBD and relieve postoperative urethral pain without affecting recovery time.Additionally,no significant adverse reactions have been observed,indicating that lidocaine can be safely used in ureteroscopic lithotripsy.(2)Intravenous infusion of 1.5mg/kg and 2.0mg/kg lidocaine significantly reduced the incidence and severity of CRBD in male patients after ureteroscopic lithotripsy,reduced the incidence of postoperative agitation in PACU,and reduced the need for postoperative remedial drugs.