Lidocaine versus Ketamine for Prevention of Postoperative Catheter Related Bladder Discomfort in Patients Undergoing Transurethral Resection of Bladder Tumor: A Randomised Controlled Trial

Abstract Background: Male patients undergoing transurethral resections of bladder tumor (TURBT) commonly suffer from catheter related bladder discomfort (CRBD). Here, the effect of intravenous lidocaine and intravenous ketamine were evaluated and compared in male patients undergoing TURBT. Methods: 130 male patients of age group 18-65 years were randomly allocated to receive intravenous lidocaine (1.5mg/kg bolus followed by 2 mg/kg/hr infusion) and intravenous ketamine (0.5 mg/kg bolus followed by 0.25 mg/kg/hr infusion) during the intraoperative period, which were discontinued once the patient was shifted to recovery room. The primary outcome evaluated was incidence of moderate to severe CRBD at 0 hr post surgery, analysed using the Fischer’s exact test. The secondary outcome was opioid requirement in the 24 hour postoperative period and severity of CRBD at 1, 2, 6 and 24 hrs post surgery, postoperative pain, side effects of lidocaine and ketamine, rescue medications (tramadol and fentanyl) used and any other complications were also assessed. Results: There were no significant differences in incidence and severity of CRBD between the 2 groups. There was a significant reduction in incidence of postoperative pain at 1 hour interval in group B (1.52 ± 1.03 vs 1.17 ± 1.29; p-0.013). Opioid requirement, rescue medication use and drug related side effect did not differ significantly between the 2 groups. Conclusion: Pre emptive administration of lidocaine reduces incidence and severity of CRBD in early postoperative period, similar to ketamine. Keywords: catheter related bladder discomfort, ketamine, lidocaine, bladder catheterization.