piperidines and Urinary-Retention

Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients.. Randomized, prospective trial.. University hospital day-surgery center.. 156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy.. Patients were randomized to either LAI (lidocaine+ropivacaine), SPIN (bupivacaine+fentanyl) or TIVA (propofol+remifentanil). Perioperative Ringer infusion was 1.5mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90.. Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered.. Surgery lasted longer in LAI group (median 40min) than in SPIN group (35min) (P=.003) and TIVA group (33min) (P<.001). Although surgery was shortest in TIVA group, TIVA patients stayed longer in the operating room than LAI patients (P=.001). Time until readiness for discharge was shorter in LAI group (93min) than in TIVA (147min) and SPIN (190min) groups (P<.001). Supplementary lidocaine infiltration was given to 32 LAI patients, and IV fentanyl to 29 LAI and 4 SPIN patients. Ephedrine was required in 34 TIVA, 5 LAI and 5 SPIN patients. One SPIN and three LAI patients had to be given TIVA and another SPIN patient LAI to complete the operations. Urinary retention was absent. Discomfort in the scar (26%) three months postoperatively was not anesthesia-related.. Logistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.

Topics: Adult; Aged; Ambulatory Surgical Procedures; Amides; Anesthesia; Anesthesia Recovery Period; Anesthetics, Intravenous; Anesthetics, Local; Bupivacaine; Feasibility Studies; Fentanyl; Hernia, Inguinal; Herniorrhaphy; Humans; Lidocaine; Male; Middle Aged; Operative Time; Patient Satisfaction; Piperidines; Propofol; Prospective Studies; Remifentanil; Ropivacaine; Urinary Retention

Peripheral mechanisms may be involved in opioid actions on the urinary bladder. This double-blind study investigated whether opioid inhibition of bladder function is reversed by methylnaltrexone, a peripheral opioid antagonist. Thirteen healthy male volunteers received an intravenous (i.v.) infusion of remifentanil, 0.15 mcg/kg/min, then a single i.v. dose of study medication (methylnaltrexone 0.3 mg/kg, naloxone 0.01 mg/kg, or saline). Urodynamics were measured with indwelling bladder and rectal catheters, and pupil size was assessed with infrared pupillometry. Remifentanil decreased detrusor pressure in 21/25 sessions and caused complete urinary retention in 18/25. Voiding was possible in 7/7, 5/12, and 0/6 sessions after naloxone, methylnaltrexone, and saline, respectively (P=0.0013). Remifentanil caused marked miosis that was reversed by naloxone, but not methylnaltrexone or placebo (P<0.0001). The pupil data confirm that methylnaltrexone did not reverse central opioid effects. Reversal of urinary retention by methylnaltrexone indicates that peripheral mechanisms may play a role in opioid-induced bladder dysfunction.

Topics: Adult; Analgesics, Opioid; Cross-Over Studies; Double-Blind Method; Humans; Infusions, Intravenous; Male; Middle Aged; Miosis; Muscle Contraction; Naloxone; Naltrexone; Narcotic Antagonists; Piperidines; Quaternary Ammonium Compounds; Remifentanil; Treatment Outcome; Urinary Bladder; Urinary Retention; Urination

A 32-year-old woman with lazy bladder was treated with cisapride (10 mg q.i.d.) for three weeks, obtaining a progressive improvement of the symptomatology and urodynamic parameters, and the return to pretreatment conditions after drug withdrawal. This case agrees with the evidence that cisapride potentiates the release of acetylcholine from postganglionic cholinergic nerves in the human isolated detrusor by activating 5-HT4 receptors, i.e. through the same mechanism responsible for its gastrointestinal prokinetic action. It is concluded that selective 5-HT4 agonists could be potentially useful to improve bladder emptying in micturition disorders associated with detrusor hypocontractility.

Topics: Adult; Cisapride; Compliance; Female; Humans; Piperidines; Sympathomimetics; Urinary Retention; Urodynamics

We report the case of a 75 old man with chronic constipation due to traumatic spinal cord injury 25 years ago. Following prostatectomy the patient developed retention of urine and urinary incontinence, which improved significantly during a therapy with cisapride (3 x 10 mg/day). While the administration of cisapride is associated with increased detrusor activity and possibly urinary incontinence in neurologically normal persons, patients with urinary retention due to spinal cord injury may benefit from a therapy with this indirect parasympathomimetic agent.

Topics: Aged; Cisapride; Constipation; Humans; Male; Parasympathomimetics; Piperidines; Spinal Cord Injuries; Urinary Retention