RECOVERY OF STORAGE AND EMPTYING FUNCTIONS OF THE URINARY-BLADDER AFTER SPINAL-ANESTHESIA WITH LIDOCAINE AND WITH BUPIVACAINE IN MEN

Background: The aim of this study was to evaluate and compare the effe cts of spinal anesthesia with lidocaine and with bupivacaine on urinar y bladder function in healthy men who were scheduled for minor orthopa edic surgical procedures. Methods: Twenty men were randomly allocated to receive either bupivacaine or lidocaine. Before spinal anesthesia, filling cystometry was performed with the patient in the supine positi on and a pressure flow study was done with the patient in the standing position. After operation, cystometric measurements were continued un til the patient could void urine spontaneously. The levels of analgesi a and of motor blockade were recorded. Results: The urge to void disap peared immediately after Injection of the local anesthetics. There was no difference in the duration of lower extremity motor blockade betwe en bupivacaine and lidocaine, Detrusor blockade lasted significantly l onger in the bupivacaine group (means +/- SD, 460 +/- 60 min) than in the lidocaine group (235 +/- 30 min). Total fluid intake and urine vol ume accumulated during the detrusor blockade were significantly higher in the bupivacaine group than in the lidocaine group. In the bupivaca ine group, the total volume of accumulated mine (875 +/- 385 ml) was a lso significantly higher than cystometric bladder capacity (505 +/- 12 0 ml) with the risk of over distension of the bladder. Spontaneous voi ding of urine did not occur until segmental sensory analgesia had regr essed to the third sacral segment. Conclusions: Spinal anesthesia with lidocaine and with bupivacaine causes a clinically significant distur bance of bladder function due to interruption of the micturition refle x. The urge to void disappears quickly and bladder function remains im paired until the block has regressed to the third sacral segment in al l patients. With long-acting local anesthetics, the volume of accumula ted urine may exceed the cystometric bladder capacity. With respect to recovery of urinary bladder function, the use of short-acting local a nesthetics for spinal anesthesia seems to be preferable.