The Preventive Effect Of Pentazocine On Urinary Catheter-related Bladder Discomfort After General Anesthesia In Department Of Neurosurgery Patients

Objective To observe the preventive effect and safety of Pentazocine on urinary catheter-related bladder discomfort after general anesthesia in department of neurosurgery patients.Methods 80 male patients underwent elective Neurosurgery,aged from 20 to 65,ASA was I-II grade.All the patients were divided into two groups: control group(Group C,n=40)and pentazocine group(Group P,n=40).There was no preoperative medication in both two groups.Arterial Blood pressure(ABP),Electrocardiogram(ECG),heart rate(HR),pulse oxygen saturation(SPO2)and BIS were monitored in the two groups after admission.Anesthesia was induced by intravenous injection of Midazolam 0.05 mg/kg,sufentanil citrate 0.4 ug/kg,etomidate 0.25 mg/kg,rocuronium 0.6 mg/kg.Mechanical ventilation was performed after tracheal intubation.Urinary catheterization after induction of anesthesia.All patients were indwelled catheter by experienced neurosurgeon according to standard procedure.Double-chamber balloon urinary catheter16 F was selected and lubricated with light paraffin oil,then placed into the urethra.After urine flowed out,the catheter was inserted into the bladder completely and distilled water was injected into the catheter 10 ml.The catheter was gently pulled back to feel the resistance.The catheter sleeve was placed in the neck of the bladder.The catheter was inserted at a depth of 25 cm.The external tape was tensionless fixed on the pubic arch.Intraoperative target controlled infusion of propofol(cpt 1~3?g/ml,Marsh)and remifentanil(cpt 1~4ng/ml,Minto),and sevoflurane 1%~2% to maintain BIS40~60.Before the end of surgery,Group P received pentazocine 0.6 mg/kg whereas patients in control group received normal saline.Grading of CRBD was done as none,mild,moderate,and severe by a blinded observer in 4h after completion of the surgery.When moderate or severe CRBD was reported,tramadol(1.5mg/kg IV)was administrated as a rescue therapy.agitation and Ramsay sedation scale scores were recorded at the time of tracheal extubation(T1),10 min(T2),30 min(T3),1 h(T4)and 4 h(T5)after extubation,and MAP,HR and SPO2 were monitored and recorded at all time points after operation.Recording the type of operation,operation time,anesthesia time,tracheal tube extraction time and hospitalization days after operation.Record the occurrence of adverse effects including PONV,respiratory depression,and blurred vision.Results There was no significant difference in general data and intraoperative data between the two groups(P>0.05).Compared with the control group,incidence and severity of CRBD were significantly decreased(P<0.05).In Group P,the agitation score of T1~T2 was decreased(P<0.05),there was no significant difference in the rest of the time(P>0.05).the Ramsay score of T1~T5 was increased(P<0.05),The blood pressure at T1,T2 and T5 was significantly lower than that in group C(P<0.05),but there was no significant difference at other times.There was no significant difference in heart rate and SPO2 at any time between the two groups(P>0.05).the rate of postoperation tramadol addition decreased and the incidence of PONV decreased(P<0.05).There was no significant difference in the incidence of respiratory depression,blurred vision and hospitalization days after operation in the two groups(P>0.05).Conclusion Pentazocine(0.6mg/kg)can significantly reduce the occurrence of catheter-related bladder irritation symptoms,moderate to severe CRBD and the severity of CRBD in department of neurosurgery patients during general anesthesia recovery period.It has good analgesic effect,less adverse reactions,which is worthy of clinical application.