局部麻醉在膀胱鏡檢查的有效性，多久才是足夠:隨機分配34位病人
陳柏華、王百孚、林介山、張進寶、江恆杰、嚴孟意
黃勝賢、陳俊吉、黃國軒、石宏仁、張建祥、陳建廷
彰化基督教醫院 外科部 泌尿科
Effect of local anesthesia for rigid cystoscopy, how long is long enough: initial data of randomizing 34 patients
Pao-Hwa Chen, Bai-Fu Wang, Jensen Lin, Chang-Pao Chang, Heng-Chieh Chiang, Meng-Yi Yan, Sheng-Hsien Huang, Chun-Chi Chen, Kuo-Hsuan Huang, Hung-Jen Shih, Jian-Xiang Zhang, Jian-ting Chen
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Purpose:
This study was done to compare the length and form of anesthesia that is suitable for patients undertaking rigid cystoscopy procedure under local anesthesia.
Material and Method:
From September 2014 to March 2015, a single Fellow surgeon performed removal of double-J catheter with rigid cystoscopy on 34 patients whom were randomized into two groups. One group received intra-uretheral injection of 4% xylocaine (2 minutes) with addition of 2% xylocaine jelly (1 minute) and another group with single dose of intra-uretheral injection of 4% xylocaine (3 minutes). Both groups received same amount of total anesthesia time (3 minutes). Several factors were used to analyze the effectiveness of local anesthesia (difference of pre and post-operative blood pressure and heart rate, VAS score, and patient’s own description). Factors that may influence the effectiveness of local anesthesia were also recorded (form of anesthesia, length of anesthesia, BMI, depression angle of bladder neck, age, and any cystoscopy finding). Bladder neck depression angle were estimated by recording the cystoscopy insertion length and the actual depression when entering the bladder. Trigonometry formula for angle using inverse sin was used to estimate the depression angle.
Result:
Thirty-four patients were included in this initial study. Initial data showed that decrease anesthesia time with liquid xylocaine, BMI, age and bladder neck depression angle of more than 30 degrees is associated with increase pain (increase in VAS and heart rate). All patients still experienced soreness even with increase length of anesthesia.
Conclusion:
Studies have shown that a minimum of 5 minutes will be needed for rigid cystoscopy examination. Due to our current environment which demands maximizing efficiency without compromising patients’ priorities, the use of adequate form and length of anesthesia should be a concern. Our initial data showed us that a liquid anesthesia with either 2 or 4% xylocaine with a minimum of 3 minutes is sufficient in performing rigid cystoscopy examination under local anesthesia.