Newly Published
Perioperative Medicine  |   November 2017
Effect of Thoracic Epidural Ropivacaine versus Bupivacaine on Lower Urinary Tract Function: A Randomized Clinical Trial
Author Notes
  • From the Departments of Anesthesiology and Pain Therapy (S.A.G., L.M.L., P.Y.W.) and Urology (M.P.S., F.C.B.), University Hospital Bern, Bern, Switzerland.
  • Submitted for publication June 12, 2017. Accepted for publication October 17, 2017.
    Submitted for publication June 12, 2017. Accepted for publication October 17, 2017.×
  • Acknowledgments: The authors thank the nurses of the urodynamic unit and Tobias Metzger, M.D., Department of Urology, University Hospital Bern, Bern, Switzerland, for their valued collaboration.
    Acknowledgments: The authors thank the nurses of the urodynamic unit and Tobias Metzger, M.D., Department of Urology, University Hospital Bern, Bern, Switzerland, for their valued collaboration.×
  • Research Support: Supported by the institutional research funds of the Department of Anesthesiology and Pain Medicine and of the Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland.
    Research Support: Supported by the institutional research funds of the Department of Anesthesiology and Pain Medicine and of the Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: patrick.wuethrich@insel.ch. Raw data available at: patrick.wuethrich@insel.ch.
    Reproducible Science: Full protocol available at: patrick.wuethrich@insel.ch. Raw data available at: patrick.wuethrich@insel.ch.×
  • Correspondence: Address correspondence to Dr. Wuethrich: University Hospital Bern, CH-3010 Bern, Switzerland. patrick.wuethrich@insel.ch. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Pharmacology / Regional Anesthesia / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   November 2017
Effect of Thoracic Epidural Ropivacaine versus Bupivacaine on Lower Urinary Tract Function: A Randomized Clinical Trial
Anesthesiology Newly Published on November 23, 2017. doi:10.1097/ALN.0000000000001980
Anesthesiology Newly Published on November 23, 2017. doi:10.1097/ALN.0000000000001980
Abstract

Background: Thoracic epidural analgesia with bupivacaine resulted in clinically relevant postvoid residuals due to detrusor underactivity. This study aimed to compare the risk of bladder dysfunction with ropivacaine versus bupivacaine using postvoid residuals and maximum flow rates. Our hypothesis was that ropivacaine would result in lower postvoid residuals, because ropivacaine has been shown to have less effect on motor blockade.

Methods: In this single-center, parallel-group, randomized, double-blind superiority trial, 42 patients undergoing open renal surgery were equally allocated to receive epidural bupivacaine 0.125% or ropivacaine 0.2%, and 36 were finally included. Inclusion criterion was normal bladder function. Patients underwent urodynamic investigations preoperatively and during thoracic epidural analgesia. Primary outcome was the difference in postvoid residual preoperatively and during thoracic epidural analgesia postoperatively. Secondary outcomes were changes in maximum flow rate between and within the groups.

Results: Median difference in postvoid residual (ml) from baseline to postoperatively was 300 (range, 30 to 510; P < 0.001) for bupivacaine and 125 (range, −30 to 350; P = 0.011) for ropivacaine, with a significant mean difference between groups (−175; 95% confidence interval −295 to −40; P = 0.012). Median difference in maximum flow rate (ml/s) was more pronounced with bupivacaine (−12; range, −28 to 3; P < 0.001) than with ropivacaine (−4; range, −16 to 7; P = 0.025) with a significant mean difference between groups (7; 95% confidence interval 0 to 12; P = 0.028). Pain scores were similar. No adverse events occurred.

Conclusions: Postvoid residuals were significantly lower using ropivacaine compared to bupivacaine for thoracic epidural analgesia reflecting less impairment of detrusor function with ropivacaine.