Abstract: Recovery of Storage and Emptying Functions of the Urinary Bladder after Spinal Anesthesia with Lidocaine and with Bupivacaine in Men

Ed. T. Kamphuis, MD, Trian I. Ionescu, Ph.D., MD, Jos de Gler, MD, Ger E. P. M. van Venrooij, Ph.D., and Tom A. Boon, Ph.D., MD. "Recovery of Storage and Emptying Functions of the Urinary Bladder after Spinal Anesthesia with Lidocaine and with Bupivacaine in Men." Anesthesiology 88 (February 1998) 2: 310-16.

Objectives:
* To compare the effects of spinal anesthesia with lidocaine and spinal anesthesia with bupivacaine on urinary bladder function in healthy men, in order to determine how best to facilitate the rapid recovery of normal bladder function after orthopaedic surgery and to prevent complications arising from the overdistension of the bladder.

Methods:
* Twenty men between the ages of 19 and 50, who were scheduled to undergo elective minor orthopaedic surgery of the lower limb during spinal anesthesia, participated in the study. The patients were randomly assigned to receive either lidocaine or bupivacaine.
* Prior to receiving spinal anesthesia, the pressure-volume relation of the bladder was measured for each patient, according to a procedure known as cystometry. This information enabled researchers to assess the activity, sensation, capacity, and compliance of the bladder muscle ("detrusor muscle"). A pressure flow study was then performed with the patient in a standing position.
* Spinal anesthesia was administered and surgery was performed. Following surgery, levels of analgesia and lower extremity motor blockade were measured by cystometry and recorded every thirty minutes, until the patient could void urine spontaneously.
* The duration of the motor blockade was defined as the time from the injection of local anesthetics until total recovery of hip, knee, and ankle motility. The duration of time from spinal injection until total recovery of bladder function was called the "detrusor block."

Results:
* The urge to void disappeared within 60 seconds after the injection of local anesthetics began for both groups.
* The detrusor blockade lasted significantly longer in patients given bupivacaine than in patients given lidocaine. The duration of lower extremity motor blockade did not differ between the lidocaine and bupivacaine groups.
* The duration of detrusor blockade was much longer than the motor blockade in both groups. "Under these conditions and without bladder catheterization, the bladder can be significantly distended. . . . Urinary retention can produce irreversible detrusor damage leading to incontinence and recurrent urinary infections."

Conclusions:
* "Spinal anesthesia with lidocaine and with bupivacaine causes a clinically significant disturbance of bladder function due to interruption of the micturition [voiding] reflex. . . . The extremely long-lasting recovery of the urinary bladder function may imply that the contents of the urinary bladder may easily exceed the cystometric capacity of the urinary bladder before normal function has reappeared, thus leading to acute postoperative distension. This justifies the need to accurately monitor the filling condition of the urinary bladder, to apply voluntary abdominal strain in case a full bladder is suspected, and ultimately single bladder catheterization if voiding is not achieved."

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