Autonomic responses during bladder hydrodistention under general versus spinal anaesthesia in patients with interstitial cystitis/bladder pain syndrome: a randomized clinical trial

Abstract

Blocking the abrupt increase in systolic blood pressure associated with autonomic response during bladder hydrodistention in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) is essential for patient safety. We conducted this study to compare autonomic responses during bladder hydrodistention in patients with IC/BPS under general and spinal anaesthesia. Thirty-six patients were randomly allocated to a general anaesthesia (GA, n = 18) or a spinal anaesthesia (SA, n = 18) group. Blood pressure and heart rate were measured continuously and ΔSBP, defined as maximum increases in SBP during bladder hydrodistention from baseline, was compared between groups. Heart rate variability was analysed using electrocardiograms. The post-anaesthesia care unit assessed postoperative pain using a numeric (0–10) rating scale. Our analyses yield a significantly greater ΔSBP (73.0 [26.0–86.1] vs. 2.0 [− 4.0 to 6.0] mmHg), a significantly lower root-mean-square of successive differences in heart rate variability after bladder hydrodistention (10.8 [7.7–19.8] vs. 20.6 [15.1–44.7] ms), and significantly higher postoperative pain scores (3.5 [0.0–5.5] vs. 0.0 [0.0–0.0]) in the GA compared to the SA group. These findings suggest that SA has advantages over GA for bladder hydrodistention in preventing an abrupt increase in SBP and postoperative pain in IC/BPS patients.

Multimodal therapies and strategies for the treatment of interstitial cystitis/bladder pain syndrome in Taiwan

“…Of the 51 articles in MEDLINE, 7 focused on the treatment of HIC, including bladder instillation with dimethyl sulfoxide solution (DMSO), 68,69 triamcinolone acetonide, 70 tacrolimus, 71 bladder injection with human embryonic stem cell, 72 and the gold standard HIC treatment with fulguration of Hunner's lesion. 73,74 The other 18 studies focused on intravesical therapy of NHIC, including analysis and interpretation of published data showing cure of IC/BPS by uterosacral ligament repair, 75 clorpactin instillation, 76 intravesical hyaluronic acid (HA) instillation [77][78][79] or botulinum toxin-A (BoNT-A) injection [80][81][82][83][84] or combined treatment, 85 intravesical lidocaine instillation, 86,87 DMSO instillation, 88,89 intravesical injections of platelet-rich plasma (PRP), 90 comparison of autonomic responses in different anesthesia types, 91 and stem cell treatment. 92 Results of most studies proved that BoNT-A can decrease the exocytosis of proinflammatory and excitatory neurotransmitters and neuropeptides, such as substance P, from primary afferent fibers that transmit nociceptive pain and participate in the development of peripheral and central sensitizations and decreases the insertion of pain-sensitive ion channels.…”