Intraoperative Bupivacaine Irrigation for Analgesia after Inguinoscrotal Surgery in Children / 대한비뇨기과학회지

Postoperative pain is a major problem that may restrict early mobilization and hospital discharge of surgical patients and it may cause psychologic trauma in pediatric patients, so effective postoperative analgesia is important especially in pediatric surgery. A study was undertaken to test the effect of intraoperative wound irrigation with bupivacaine for postoperative analgesia in pediatric inguinoscrotal surgery and the analgesic effect was measured with postoperative analgesics requirement and pain score. A total of 149 patients of 5 months to 13 years old were enrolled in our study. In comparison of analgesics requirement a total of 69 patients were enrolled and assigned to 2 groups. Group 1 was treated with wound irrigation with 0.21 ml/kg 0.25 % bupivacaine solution before closure of the inguinal canal and before suturing the subcutaneous layer. Group 2 was treated with normal saline instead of bupivacaine. Postoperatively 3 mg/kg phenobarbital was administered intramuscularly on complaint of pain. And the total number of doses of phenobarbital administered during first 24 hours of postoperative period was recorded. Drug administration and patient evaluation were double-blinded. In comparison of pain score a total of 80 patients were enrolled and assigned to 2 groups as same method as above and score according to the Oucher pain scale was recorded by nursing staff to assess the efficacy of intraoperative bupivacaine irrigation. The children in the bupivacaine group required significantly less postoperative medication for analgesia than those in the control group. The average number of doses of phenobarbital in the bupivacaine group was 0.189 +/- 0.065 compared to 0.594 +/- 0.109 in the control group (p=0.002). On the Oucher pain scale the bupivacaine group reported less pain than the control group (score 27.69 +/- 6.04 versus 37.56 +/- 5.18, respectively, p=0.01). We concluded that bupivacaine irrigation effectively decreases postoperative pain and narcotic drug requirement, and the irrigation of wounds with bupivacaine should be a routine procedure in elective inguinoscrotal surgery in children.

Maximum Detrusor Pressure Measurement by Eyeball Urodynamic Study in the Diagnosis and Postoperative Follow-up in BPH / 대한비뇨기과학회지

It is known that the diagnostic accuracy is about 75% by conventional method without pressure/ flow study in BPH. But we cannot apply the pressure/flow study to the every patient in the diagnosis of BPH due to high cost of equipment and invasiveness of the study. Generally, in compensatory phase with obstruction, we can diagnose obstruction easily because maximum urine flow rate is decreased and maximum intravesical pressure is high. But in decompensatory phase with obstruction we must perform invasive pressure/flow study to differentiate obstruction from the patient with decreased detrusor contractility without obstruction because urine flow rate is decreased and maximum intravesical pressure is low in both cases. We diagnosed obstruction if the maximum flow rate is lower than 15 ml/sec and the maximum intravesical pressure is higher than 50 cm H2O by eyeball urodynamic study and if URA is higher than 29 cm H2O by invasive pressure/flow study in the patient whose maximum flow rate is lower than 15 cc/sec with less than 50 cm H2O of maximum intravesical pressure by eyeball urodynamic study. We diagnosed 141 BPH patients in which 116 (82.3%) patients by eyeball urodynamic study and 25 (17.7%) patients by pressure/flow study and treated them by open prostatectomy or TURP. Symptoms were improved in 120 (83%) patients within 3 months. Ten (8.0%) out of 21 (17%) patients whose symptoms were not improved after 3 months with higher than 15 ml/sec of maximum flow rate were diagnosed as increased detrusor contractility. Eyeball urodynamic study was performed in the other 11 (8.9%) patients with lower than 15 ml/sec of maximum flow rate. Six (4.8%) of them were diagnosed as decreased detrusor contractility due to lower than 50 cm H2O of maximum intravesical pressure and the other 5 (4.O%) were diagnosed as obstruction due to higher than 50 cm H2O of maximum intravesical pressure in eyeball urodynamic study. Five (4.0%) patients had urinary incontinence. Four (3.2%) out of them had detrusor contractility and the other one had obstruction. Alpha blockers or anticholinergics were applied in the patient with increased detrusor contractility, CIC or Foley catheter was indwelled in the patients with decreased detrusor contractility. Repeated TURP or urethral dilation was applied to the patient with obstruction After all symptoms were improved in all patients except 3 (2.4%). In conclusion maximum detrusor pressure measurement with eyeball urodynamic study is very useful and less sophisticated method in the diagnosis and postoperative follow-up in BPH.