Management of post-operative bladder spasm.
OBJECTIVE
Pain management following bladder surgery in children is often complicated by bladder spasm. The overall severity of spasm can be reduced with opioids, anticholinergic medication and sedatives, although breakthrough spasms often occur. At the Royal Children's Hospital, Melbourne, intravesical bupivacaine has been used to manage postoperative bladder spasm to good effect. The administration of intravesical bupivacaine is analysed in this prospective audit of locally applied intravesical anaesthetic and compared with other methods.


METHODS
From February to August 2003, histories of 58 patients who had intravesical bupivacaine were studied and compared with six other methods of management of postoperative bladder spasm.


CONCLUSIONS
Data showed that epidural anaesthesia was the most effective treatment of pain, with a pain score reduction of 6.6, compared with a reduction of 6.1 with intravesical bupivacaine, and 4.5 using intravenous morphine. However, intravesical bupivacaine was the most effective method for the relief of bladder spasm.
Chiang
D
D
Paediatric Urology Unit, Sunshine Hospital, and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Ben-Meir
D
D
Pout
K
K
Dewan
P A
PA
D000082:Acetaminophen / Q000627:therapeutic use; D000283:Administration, Intravesical; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013035:Spasm / Q000145:classification / Q000188:drug therapy*; D001743:Urinary Bladder / Q000601:surgery*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000082:Acetaminophen; D003061:Codeine; D002045:Bupivacaine