Effect of Thoracic Epidural Ropivacaine versus Bupivacaine on Lower Urinary Tract Function: A Randomized Clinical Trial.

Girsberger, Stefan Alexander; Schneider, Marc Philipp; Löffel, Lukas M; Burkhard, Fiona C.; Wüthrich, Patrick Yves (2018). Effect of Thoracic Epidural Ropivacaine versus Bupivacaine on Lower Urinary Tract Function: A Randomized Clinical Trial. Anesthesiology, 128(3), pp. 511-519. Lippincott Williams & Wilkins 10.1097/ALN.0000000000001980

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BACKGROUND Thoracic epidural analgesia with bupivacaine resulted in clinically relevant postvoid residuals due to detrusor underactivity. This study aimed to compare the risk of bladder dysfunction with ropivacaine versus bupivacaine using postvoid residuals and maximum flow rates. Our hypothesis was that ropivacaine would result in lower postvoid residuals, because ropivacaine has been shown to have less effect on motor blockade. METHODS In this single-center, parallel-group, randomized, double-blind superiority trial, 42 patients undergoing open renal surgery were equally allocated to receive epidural bupivacaine 0.125% or ropivacaine 0.2%, and 36 were finally included. Inclusion criterion was normal bladder function. Patients underwent urodynamic investigations preoperatively and during thoracic epidural analgesia. Primary outcome was the difference in postvoid residual preoperatively and during thoracic epidural analgesia postoperatively. Secondary outcomes were changes in maximum flow rate between and within the groups. RESULTS Median difference in postvoid residual (ml) from baseline to postoperatively was 300 (range, 30 to 510; P < 0.001) for bupivacaine and 125 (range, -30 to 350; P = 0.011) for ropivacaine, with a significant mean difference between groups (-175; 95% confidence interval -295 to -40; P = 0.012). Median difference in maximum flow rate (ml/s) was more pronounced with bupivacaine (-12; range, -28 to 3; P < 0.001) than with ropivacaine (-4; range, -16 to 7; P = 0.025) with a significant mean difference between groups (7; 95% confidence interval 0 to 12; P = 0.028). Pain scores were similar. No adverse events occurred. CONCLUSIONS Postvoid residuals were significantly lower using ropivacaine compared to bupivacaine for thoracic epidural analgesia reflecting less impairment of detrusor function with ropivacaine.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Urologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Urologie

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Girsberger, Stefan Alexander; Schneider, Marc Philipp; Burkhard, Fiona C. and Wüthrich, Patrick Yves

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0003-3022

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

15 Dec 2017 08:28

Last Modified:

22 Nov 2018 02:30

Publisher DOI:

10.1097/ALN.0000000000001980

PubMed ID:

29189291

BORIS DOI:

10.7892/boris.107624

URI:

https://boris.unibe.ch/id/eprint/107624

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