Evaluation of optimal epidural insertion site for catheter-related bladder discomfort after transurethral resection of prostate

Purpose In transurethral resection of the prostate (TURP), catheter-related bladder discomfort (CRBD) frequently occurs after TURP. The purpose of the present study was to investigate the effective epidural insertion site to prevent CRBD after TURP. Methods Thirty patients, who were scheduled to undergo TURP under general anesthesia combined with epidural anesthesia were divided into two groups (caudal or thoracic epidural anesthesia). Caudal or thoracic epidural catheter was placed before induction of anesthesia. Ten minutes before the start of surgery, 6 ml of 0.25% ropivacaine was injected through the epidural catheter. Patient-controlled epidural analgesia (PCEA) including fentanyl, ropivacaine, and droperidol was initiated 1 hour after the start of surgery and continued for 24 hours postoperatively. The severity of CRBD was assessed at 6, 12, and 24 hours after surgery by four point scale. The 24-hour doses of PCEA solution, number of requests, and number of boluses were also evaluated. Results Severity of CRBD was not different between the two groups at the three observation time points. Over the 24-hour period, the amount of drug solution used in PCEA was similar in both groups. The number of PCEA demand and bolus in 24 hours was also not different between the two groups. Conclusions The suppression of CRBD after TURP surgery was comparable between caudal and thoracic epidural anesthesia. Because caudal epidural anesthesia is difficult to catheterize without the use of an ultrasound device, it may be simpler to use a thoracic epidural with fentanyl for PCEA to prevent CRBD. Trial registration the full name of the registry;University Hospital Medical Information Network(UMIN),the trial registration number;UMIN000041625,the date of registration is August 31,2020.