Levobupivacaine intravesical injection for superficial bladder tumor resection--possible, effective, and durable. Preliminary clinical data.
BACKGROUND
General and spinal anesthesia are currently in widespread use during transurethral bladder tumor resection. However, local anesthetic methods are claimed to provide sufficient intra-operative analgesia and satisfactory post-operative pain management. We evaluated whether local levobupivacaine infiltration of the tumor would result in outcomes, in terms of intra-operative analgesia, similar to those for utilization of general anesthesia. Post-operative analgesia and patient satisfaction were also assessed.


METHODS
Twenty patients with recurrent solitary bladder tumors were randomly allocated in two groups. Group A, underwent tumor resection under general anesthesia and group B was treated with resection after local levobupivacaine infiltration. Post-operative analgesia was evaluated with utilization of a visual analogue scale, ranging from 0 to 10, with higher scores indicating more intense pain perception.


RESULTS
Group A patients demonstrated significantly lower visual analogue scale scores at t=0, which peaked at 4 h post-operatively. Group B scores were higher at t=0, declined over a 2 h interval and reached zero after t=4 h. Patients younger than 60 years and women benefitted more. Local anaesthesia was the method of pain control preferred by 90% of patients.


CONCLUSIONS
Local levobupivacaine infiltration for transurethral bladder tumor resection seems feasible, providing intra and post-operative pain control. In this preliminary setting, general anesthesia provided a higher level of pain control in the immediate post-operative period (<4 h) while local levobupivacaine infiltration demonstrated excellent late post-operative analgesia (>4 h). Also, patients seem to prefer local to general anesthesia in future surgery.
Stravodimos
K G
KG
1st Urology Department, Laiko General Hospital, University of Athens Medical School, 17 Ag. Thoma St, 11527 Goudi, Athens, Greece.
Mitropoulos
D
D
Salvari
A
A
Lampadariou
A
A
Kapetanakis
T
T
Zervas
A
A
D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010147:Pain Measurement; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine