Necmettin TARAK, Demet LAFLI TUNAY, Numan BERK, Sinan KARADAYI, A. Geylan IŞIK

Ürolojik Girişimlerde Kalıcı Üretral Kateterizasyon Uygulananan Hastalarda Postoperatif Katetere Bağlı Ağrı Üzerine Lidokainin Farklı Uygulama Yollarının Etkisi

Amaç: Bu çalışma ile ürolojik girişimlerde, üretral kateterizasyon uygulananan erişkin erkek hastalarda, üretral katetere bağlı visseral ağrı üzerine lidokainin farklı uygulama yollarının etkinliği araştırılmak istenmiştir. Gereç ve Yöntem: Çift kör randomize kontrollü bu çalışmaya, ASA I-III sınıfı, 18 - 80 yaş arası, genel anestezi ile beraber üretral kateterizasyon uygulanan 80 erkek hasta dahil edildi. Hastalar bilgisayar aracılı randomizasyon yöntemi kullanılarak rasgele dört gruba ayrıldı. Grup 1 (n=20)’de, operasyon bitiminden 15 dakika önce 100 mg/20mL lidokain üretral kateterden intravezikal olarak verildi ve üretral kateter klemplendi. Operasyon bitiminde klemp açıldı. Grup 2 (n=20)’de, operasyon başlamadan önce lidokainli cathejell katetere sürülerek üretral kateterizasyon yapıldı. Grup 3 (n=20)’te operasyon başlamadan önce lidokainli cathejell katetere sürülerek üretral kateterizasyon uygulandı ve operasyon bitiminden 15 dakika önce 100 mg/20mL lidokain üretral kateter yolu ile intravezikal olarak verildi ve üretral kateter klemplendi. Operasyon bitiminde klemp açıldı. Grup 4 (n=20) kontrol grubu olarak kabul edildi ve operasyon başlamadan önce üretral kateter takılırken katetere lubrikan (ilaçsız) sürüldü. Postoperatif dönemde hastalar 2 saat boyunca postoperatif takip ünitesinde tutularak postoperatif 5., 15., 45. dakika ile 1. ve 2. saatte vizüel ağrı skorları (VAS), sistolik ve diastolik kan basınçları, kalp atım hızları ve yan etkiler kaydedildi. Aynı parametreler 4. ve 6. saatlerde de üroloji servisinde kaydedildi. Bulgular: Lidokainli jel ile intravezikal lidokainin kullanıldığı grup (Grup 3)’ta VAS skorları en düşük bulunurken, gruplar arasında en yüksek VAS değerleri kontrol grubunda idi. Hiçbir olguda yan etkiye rastlanmadı. Sonuç: Üretral kateterizasyona bağlı ağrıyı azaltmada, lidokainli jel ile intravezikal lidokainin birlikte kullanımının, bu yöntemlerin tek başına uygulanmasına göre daha etkili bir uygulama olduğu kanısına varıldı.

Anahtar Kelimeler:

Cathejell, lidokain, üretral kateterizasyon

Evaluation of Pressure Sores in Intensive Care; What Situation Are We In?

INTRODUCTION: Pressure sores are a serious health problem that is common in the intensive care unit (ICU), increasing the length of hospital stay, cost and mortality rate, and should be prevented first. This study was conducted in order to determine the risk factors that may affect our pressure sore prevalence and development METHOT: The pressure sore data of the patients treated in the Anesthesia Intensive Care Unit for six months between June 1, 2019 and December 31, 2019 were examined. The demographic characteristics, hospitalization diagnoses, pressure sore risk factors, locations and stages of the patients with pressure sores were recorded. RESULTS: The number of patients followed up during the six-month period was 275, and 52 of the patients had pressure sores (18.9%). Forty of the patients were 65 years and older, and advanced age was found to be a significant risk factor (p <0.01). Considering the patients who developed pressure sores in our intensive care follow-up, it was seen that the average pressure sore development day was 17.1st day. (3rd-44th day) Pressure sores were most common in the sacral region and stage two. CONCLUSION: While the most important risk factors for pressure ulcer development were emphasized as advanced age; in our study, in parallel with the literature, advanced age was the most common . Pressure sores rate and analysis, which is one of the mandatory parameters as an indicator of quality in intensive care, is one of the issues that should be dominated by every intensive care worker.

Keywords:

pressure sores, intensive care quality indicators, braden risk scale,

PDF

___

1. Binhas M, Motamed C, Hawajri N, et al. . Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim. 2011;30:122–5.
2. Wilson M. Causes and management of indwelling urinary catheter-related pain. Br J Nurs. 2008;17:232-9.
3. Bala I, Bharti N, Chaubey VK, et al. . Efficacy of gabapentin for prevention of postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor. Urol. 2012;79:853–7.
4. Bai Y, Wang X, Li X, et al. Management of catheter-related bladder discomfort in patients who underwent elective surgery. J Endourol. 2015;29:640–9. doi: 10.1089/end.2014.0670.
5. Tzortzis V, Gravas S, Melekos MM, et al. Intraurethral lubricants: a critical literature review and recommendations. J Endourol. 2009;23:821-6.
6. Wilson M. Causes and management of indwelling urinary catheter-related pain. Br J Nurs. 2008;17:232-9.
7. Li C, Liu Z, Yang F. Predictors of catheter-related bladder discomfort after urological surgery. J Huazhong Univ Sci Technolog Med Sci. 2014;34:559–62.
8. Maro S, Zarattin D, Baron T, et al. Catheter-related bladder discomfort after urological surgery: Importance of the type of surgery and efficiency of treatment by clonazepam. Prog Urol. 2014;24:628–33.
9. Andersson KE. Detrusor myocyte activity and afferent signaling. Neurourol Urodyn. 2010;29:97–106.
10. Weinberg AC, Woldu SL, Bergman A, et al. Dorsal penile nerve block for robot-assisted radical prostatectomy catheter related pain: A randomized, double-blind, placebo-controlled trial. Springerplus. 2014;3:181.
11. Kumar A, Griwan MS, Singh SK, et al. Is periprostatic nerve block a gold standard in case of transrectal ultrasound-guided prostate biopsy? Urol Ann. 2013;5:152–6.
12. Tommaselli GA, Di Carlo C, Formisano C, et al. Effect of local infiltration analgesia on post-operative pain following TVT-O: A double-blind, placebo-controlled randomized study. Arch Gynecol Obstet. 2014;290:283–9.
13. Xiaoqiang L, Xuerong Z, Juan L, et al. Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries: A randomized, controlled, double-blind trial. Medicine. 2017; 96(49):e8932. doi: 10.1097/MD.0000000000008932.
14. Aaronson DS, Walsh TJ, Smith JF, et al. Meta-analysis: does lidocaine gel before flexible cystoscopy provide pain relief? BJU Int. 2009;104:506–9.
15. Birch BRP, Ratan P, Morley R, et al. Flexible cystoscopy in men: is topical anaesthesia with lignocaine gel worthwhile? Br J Urol. 1994;73:155–9.
16. McFarlane N, Denstedt J, Ganapathy S, et al. Randomized trial of 10 ml and 20 ml of 2% intraurethral lidocaine gel and placebo in men undergoing flexible cystoscopy. J Endourol 2001; 15(5):541–4.
17. Srivastava P, Lai HH, Mickle AD. (2020). Characterization of a method to study urodynamics and bladder nociception in male and female mice. Low Urin Tract Symptoms. 2021;13(2):319-24. doi: 10.1111/luts.12365. Epub 2020 Nov 17.
18. Meng E, Hsu YC, Chuang YC. Advances in intravesical therapy for bladder pain syndrome(BPS)/interstitial cystitis (IC). Low Urin Tract Symptoms. 2018;10:3–11. https://doi.org/10.1111/luts.12214.
19. Heesakkers J, Chapple C, Ridder DD, et al. Practical Functional Urology: Springer 2016.
20. Zhou Y, Wang Y, Abdelhady M, et al. Change of vanilloid receptor 1 following neuromodulation in rats with spinal cord injury. J Surg Res. 2002;107:140–4.
21. Yokoyama O, Ishiura Y, Nakamura Y, et al. Urodynamic effects of intravesical instillation of lidocaine in patients With overactive detrusor. J Urol. 1997;157:1826–30.
22. Pode D, Zylber-Katz E, Shapiro A. Intravesical lidocaine: topical anesthesia for bladder mucosal biopsies. J Urol. 1992;148(3): 795–6.
23. Amano T, Ohkawa M, Kunimi K, et al. Topical anaesthesia for bladder biopsies and cautery: intravesical lidocaine versus caudal anaesthesia. Int Urol Nephrol. 1995;27: 533–7.
24. Asklin B, Cassuto J. Intravesical lidocaine in severe interstitial cystitis. Case report. Scand J Urol Nephrol. 1989;23:311–2.
25. Giannakopoulos X, Champilomatos P. Chronic interstitial cystitis. Successful treatment with intravesical lidocaine. Arch Ital Urol Nefrol Androl. 1992;64(4):337–9.
26. Solinsky R, Linsenmeyer TA. Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change. J Spinal Cord Med. 2018;10;42(5):1-5. doi: 10.1080/10790268.2018.1518764.
27. Yokoyama O, Komatsu K, Kodama K, et al. Diagnostic value of intravesical lidocaine for overactive bladder. J Urol. 2000;164(2):340-3.