Transurethral Ropivacaine (100 mg) Bladder Irrigation Reduces the Incidence of Bladder Discomfort in Transurethral Resection of Bladder Tumor: A Randomized Double-blind Trial

BACKGROUND: Catheter-related bladder discomfort (CRBD) is frequent after transurethral resection of bladder tumor (TURBT) and adversely affects early recovery. Pharmacological strategies exist but are often limited by side effects. We evaluated whether a single intravesical instillation of ropivacaine at the end of TURBT reduces postoperative CRBD. METHODS: In this prospective, double-blind, randomized controlled trial, 162 adults undergoing TURBT under spinal anesthesia were allocated to receive bladder irrigation with either 100 mL of 0.1% ropivacaine (100 mg) or 100 mL of saline for 10 min immediately after surgery. The primary endpoint was the incidence of CRBD in the postanesthesia care unit (PACU). Secondary outcomes included CRBD severity over 24 h, postoperative pain scores (0-6 h), need and timing of rescue analgesia, patient satisfaction at 6 h, urinary symptom-related quality of life at day 10, and safety parameters. RESULTS: Baseline characteristics were similar between groups. Ropivacaine irrigation increased the proportion of patients free of CRBD in the PACU compared with saline (49.4% vs. 34.6%; absolute difference 14.8%, 95% confidence interval [CI]: 4.9-24.7). At 24 h, 96.3% of patients in the ropivacaine group were CRBD-free compared with 87.7% in the control group (difference: 8.6%, 95% CI: 0.1-17.1). Pain scores were lower with ropivacaine at 3-5 h (all P < 0.001). Rescue analgesia was required less frequently (25.9% vs. 42.0%, P = 0.04) and later (186 ± 43 vs. 143 ± 40 min, P < 0.001). Patient satisfaction at 6 h was higher in the ropivacaine group (mean score: 6.3 ± 0.9 vs. 5.5 ± 1.1). Hemodynamic variables remained stable in both groups, and no severe adverse events occurred. CONCLUSION: Intravesical ropivacaine 100 mg given as irrigation at the end of TURBT significantly reduced immediate postoperative CRBD, lowered early pain scores, decreased the need for rescue analgesia, and improved short-term satisfaction without additional safety concerns. This simple and inexpensive intervention may be considered as part of enhanced recovery protocols in urological surgery.