Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled
T ial. MAR Oncology and Hema ology. (2025) 5:09
Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e
Rela ed Bladde Discom o in Pa ien s Unde going T ansu e h al
Resec ion o Bladde Tumo : A Randomised Con olled T ial
Rumi Sood1, Anuja Pandi 2*, Gi a ha Goswami3, Renoxy Bansal4 , Shi ali Aga wal5 , Ni isha Sood6
1,2,3,4. All India Ins i u e o Medical Sciences, New Delhi, India.
5. A emis Hospi al , Gu gaon , Ha yana
6. Maha aja Ag eson sa Na ain Gup a hospi al, Ha yana
*Co espondence o: Anuja Pandi , All India Ins i u e o Medical Sciences, New Delhi, India.
Copy igh .
© 2025 Anuja Pandi This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion
License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal
wo k is p ope ly ci ed.
Recei ed: 02 Sep 2025
Published: 16 Sep 2025
MAR Oncology and Hema ology (2025) 5:09
Resea ch A icle
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
Page 2 o 12
Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
In oduc ion
U ina y Bladde ca he e isa ion can esul in eeling o discom o , u gency and equency. These symp oms
ha e been e e ed o as ca he e ela ed bladde discom o (CRBD) which can con inue in he pos ope a i e
pe iod. The incidence o CRBD has been epo ed o be 40-80% 1-5. CRBD is s ongly associa ed wi h bladde
ca he e size mo e han 18 F , male gende and pa ien s unde going TURBT. 1, 6 Mild CRBD is ole able in
mos o he pa ien s bu mode a e o se e e CRBD can be dis essing in he pos ope a i e pe iod impac ing
Abs ac
Backg ound: Male pa ien s unde going ansu e h al esec ions o bladde umo (TURBT)
commonly su e om ca he e ela ed bladde discom o (CRBD). He e, he e ec o
in a enous lidocaine and in a enous ke amine we e e alua ed and compa ed in male pa ien s
unde going TURBT.
Me hods: 130 male pa ien s o age g oup 18-65 yea s we e andomly alloca ed o ecei e
in a enous lidocaine (1.5mg/kg bolus ollowed by 2 mg/kg/h in usion) and in a enous
ke amine (0.5 mg/kg bolus ollowed by 0.25 mg/kg/h in usion) du ing he in aope a i e pe iod,
which we e discon inued once he pa ien was shi ed o eco e y oom. The p ima y ou come
e alua ed was incidence o mode a e o se e e CRBD a 0 h pos su ge y, analysed using he
Fische ’s exac es . The seconda y ou come was opioid equi emen in he 24 hou
pos ope a i e pe iod and se e i y o CRBD a 1, 2, 6 and 24 h s pos su ge y, pos ope a i e
pain, side e ec s o lidocaine and ke amine, escue medica ions ( amadol and en anyl) used
and any o he complica ions we e also assessed.
Resul s: The e we e no signi ican di e ences in incidence and se e i y o CRBD be ween he
2 g oups. The e was a signi ican educ ion in incidence o pos ope a i e pain a 1 hou in e al
in g oup B (1.52 ± 1.03 s 1.17 ± 1.29; p-0.013). Opioid equi emen , escue medica ion use
and d ug ela ed side e ec did no di e signi ican ly be ween he 2 g oups.
Conclusion: P e emp i e adminis a ion o lidocaine educes incidence and se e i y o CRBD
in ea ly pos ope a i e pe iod, simila o ke amine.
Keywo ds: ca he e ela ed bladde discom o , ke amine, lidocaine, bladde ca he e iza ion.
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
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Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
he quali y o pos ope a i e ca e and may equi e addi ional analgesic he apy. The e o e app op ia e
managemen o CRBD is mus o imp o e pa ien sa is ac ion and pos ope a i e ou comes.
CRBD is induced by in olun a y con ac ions o he bladde smoo h muscle due o ac i a ion o he bladde
musca inic ecep o s o in lamma o y s imula ion.7 The e o e a ange o agen s, such as an icholine gics,
ke amine, amadol ha e been e alua ed in a ious s udies o he p e en ion o ea men o CRBD.2 Despi e
a ailabili y o all hese agen s, he e is a e y li le e idence o hei usage o he ea men wi hou side
e ec s.8,9
Ke amine is known o in e ac wi h mul iple binding si es, including NMDA and non-NMDA glu amine
ecep o s, mono-aminogenic and opioid ecep o s, nico inic and musca inic choline gic ecep o s.
Theo e ically, ke amine can educe he con ac ile esponse o he smoo h muscles by an e ec on he cen al
ne ous sys em, he p eganglionic ib es, he nico inic ecep o s in he pos synap ic memb ane o he
in amu al ganglion, he pos synap ic ib es, he musca inic ecep o s, he chemical signal ansmission
be ween he ecep o s and he con ac ile elemen s, he con ac ile elemen o any combina ion abo e. Du ieux
demons a ed ha clinically ele an concen a ion o ke amine p o oundly inhibi musca inic ecep o
signalling.10
Whe eas in a enous lidocaine has go mul i ac o ial pha macological e ec s including analgesic,
an icholine gic, an i-in lamma o y and an ihype algesic p ope ies. Based on hese conside a ions we
hypo hesized ha in a enous lidocaine can educe he incidence o mode a e o se e e CRBD. So, in his
s udy we compa ed he ole o in a enous ke amine and in a enous lidocaine o p e en ion o CRBD in
pa ien s unde going TURBT. The s udy also no es he pos ope a i e pain, escue medica ions used, side e ec s
o bo h he d ugs and any complica ions du ing he su ge y.
Me hods
This was a p ospec i e andomised ial egis e ed p io o pa ien s en olmen wi h Clinical ial egis y India
ICMR-NIMS (CTRI/2022/09/045172, da e o egis a ion – 2/09/2022) and was app o ed by All India
Ins i u e o Medical Sciences New Delhi ins i u ional e hical commi ee. 130 consen ing male pa ien s o age
g oup 18-65 y s, ASA g ade I & II unde going TURBT we e assessed o eligibili y and included in he s udy
a e aking w i en in o med consen s. Pa ien s we e excluded om he s udy i he e was delayed ex uba ion,
admission o in ensi e ca e uni , his o y o opium abuse o ch onic pain, pa ien al eady ca he e ized, his o y
o u ina y ac obs uc ion equi ing su gical in e en ion, his o y o neu ological diso de , li e , hea
disease, o e ac i e bladde , and mo bid obesi y. The conso ’s low cha is depic ed in he s udy ( ig 1).
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
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Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
Fig 1 . CONSORT low diag am o pa ien s included in he s udy. G oup A comp ised pa ien s who ecei ed
in a enous ke amine. G oup B comp ised pa ien s who ecei ed in a enous lidocaine. CONSORT
indica es Consolida ed s anda ds o epo ing ials.
All he pa ien s we e educa ed abou symp oms o CRBD a day p io o su ge y. A e shi ing pa ien o
su ge y, NIBP, pulse oxime y, ECG, capnog aphy, skin empe a u e p obe, and BIS we e applied o all
pa ien s. Gene al anes hesia induc ion was pe o med wi h an injec ion o en anyl 2mcg/kg, p opo ol 1.5
mg/kg, a acu ium 0.5mg/kg. Once he pa ien was unconscious, la yngeal mask ai way (LMA) was inse ed
and anes hesia was main ained using se o lu ane in an ai /oxygen mix u e and end idal concen a ion o
se o lu ane was adjus ed o main ain a a ge BIS alue o 40-60 and app op ia e i al signs. The lidocaine
and ke amine dose egime was de e mined based on he p e ious s udy wi h some modi ica ions. In g oup A
in a enous bolus o ke amine 0.5mg/kg jus p io o induc ion ollowed by in usion o ke amine a 0.25
mg/kg/h. In g oup B in a enous bolus o 2% lidocaine 1.5 mg/kg jus p io o induc ion ollowed by
2mg/kg/h in usion was used. To e e se neu omuscula blockade, neos igmine 0.04 mg/kg and glycopy ola e
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
Page 5 o 12
Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
8mcg/kg we e adminis e ed. A he end o su ge y U ina y ca he e mo e han 20 F was inse ed and balloon
was in la ed wi h 10 ml dis illed wa e . A 2% lidocaine gel was used o lub ica e he ca he e . No mal saline
was in used con inuously h ough he u ina y ca he e o i iga e he bladde . A e con i ming ha he pa ien
is ully conscious and eco e ed om neu omuscula blockade, La yngeal mask ai way was emo ed and
pa ien was shi ed o Pos ope a i e ca e uni .
In Pos ope a i e ca e uni , Inj. pa ace amol 1 gm was adminis e ed as escue analgesic and inj. en anyl was
gi en o pa ien s complaining o pain NRS>4 and inj. amadol 50 mg was gi en o he pa ien complaining
o mode a e o se e e CRBD a any poin o ime .I pa ien complained o bo h pos ope a i e pain wi h NRS
>4 and mode a e-se e e CRBD simul aneously hen ei he amadol o en anyl was adminis e ed acco ding
o he mo e signi ican complain . The pa ien was eassessed a e 15 minu es. The same analgesic p o ocol
was main ained in wa d.
The se e i y o CRBD was eco ded a 0, 1, 2, 6 and 24 h s wi h none as no complain , mild as epo ed by
pa ien only when asked, mode a e as epo ed by pa ien s independen ly and se e e as epo ed by pa ien s
wi h beha io al esponse such as lailing limbs, s ong ocal esponse, and a emp s o pull ou ca he e .2
Pos ope a i e pain was also e alua ed a 0, 1, 2, 6 and 24 h wi h a Nume ical a ing scale (NRS) in which 0
is no pain and 10 is wo s pain. Addi ionally Pos ope a i e seda ion was e alua ed wi h Ramsay seda ion
scale11 along wi h pos ope a i e nausea omi ing, hallucina ions, diplopia, espi a o y dep ession,
ca dio ascula dep ession and seizu es. The du a ion o su ge y and escue medica ions ( en anyl o amadol)
used we e also eco ded. All he e alua ions we e eco ded by blinded anaes hesiologis in pos ope a i e ca e
uni .
S a is ical analysis
The s udy o Reza, e al obse ed ha incidence o CRBD a 0 hou was 38.60% and a 1 hou was 22.81% in
Ke amine g oup. Taking hese alues as e e ence and assuming di e ence o 25% in incidence o CRBD
be ween Ke amine and Lidocaine, he minimum equi ed sample size wi h 80% powe o s udy and 5% le el
o signi icance is 59 pa ien s in each s udy g oup. To educe ma gin o e o , o al sample size aken was 130
(65 pa ien s pe g oup).
Fo mula used was:-
n>=((pc*(1-pc)+pe*(1-pe))*(Zα + Zβ)2)/(pc-pe)2
wi h
pc= incidence o CRBD in Ke amine g oup
pe= incidence o CRBD in Lidocaine g oup
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
Page 6 o 12
Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
Whe e Zα is alue o Z a wo sided alpha e o o 5% and Zβ is alue o Z a powe o 80% .Ca ego ical
a iables we e p esen ed in numbe and pe cen age (%) and con inuous a iables was p esen ed as mean ± SD
and median. No mali y o da a was es ed by Kolmogo o -Smi no es . The da a no mali y was checked by
using Kolmogo o -Smi no es . The cases in which he da a was no no mal, we used non pa ame ic es s.
The compa ison o he a iables which we e quan i a i e and no no mally dis ibu ed in na u e we e analysed
using Mann-Whi ney Tes and a iables which we e quan i a i e and no mally dis ibu ed in na u e we e
analysed using Independen es . The compa ison o he a iables which we e quali a i e in na u e we e
analysed using Chi-Squa e es . I any cell had an expec ed alue o less han 5 hen Fishe ’s exac es was
used. The da a en y was done in he Mic oso EXCEL sp eadshee and he inal analysis was done wi h he
use o S a is ical Package o Social Sciences (SPSS) so wa e, IBM manu ac u e , Chicago, USA, e sion
25.0.Randomiza ion was done wi h block andomiza ion wi h sealed en elope sys em:- In his, we p epa ed
en andomly gene a ed ea men alloca ions wi hin sealed opaque en elopes assigning A and B in 5
en elopes each, whe e A ep esen s ke amine g oup and B ep esen s lidocaine g oup. Once a pa ien
consen ed o en e a ial an en elope was opened and he pa ien was hen o e ed he alloca ed g oup. Hence,
pa ien s we e andomized in a se ies o blocks o en.
Resul s
Ini ially 65 pa ien s we e alloca ed in each g oup bu in g oup B he e was one d op ou as he pa ien was
shi ed o In ensi e ca e uni . The 2 g oups did no ha e signi ican di e ences in an h opome ic baseline
cha ac e is ics (Table 1). Du a ion o su ge y was simila in bo h he g oups (P>0.05; Table 1) bu he g oups
we e no simila on he basis o age (P<0.05).
In pos ope a i e ca e uni , incidence and se e i y o CRBD we e simila in bo h he g oups a 0, 1, 2, 6 and
24 hou s (P>0.05; Table 2, ig 2)
The e was signi ican educ ion in incidence o pain a 1 hou in e al in g oup B when compa ed o g oup A.
(P-0.013, Table 3)
Incidence o seda ion was 1.56% in g oup B and 0% in g oup A (P>0.05). Incidence o PONV was simila in
bo h he g oups. 5 pa ien s in g oup A and 6 pa ien s in g oup B ecei ed en anyl o elie o pain; his
di e ence was no s a is ically signi ican . None o he pa ien in ei he g oup had espi a o y dep ession,
seizu es, delayed ex uba ion and local anes he ic sys emic oxici y. Hallucina ions we e seen in one o he
pa ien in g oup A, bu i esol ed wi hou any need o in e en ion a he 1-hou isi . (Table 4)
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
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Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
Table 1. Age, An h opome ic cha ac e is ics o he pa ien s, and su ge y du a ion be ween g oup A and B
G oup A
G oup B
P alue
Age (y ) (mean±SD)
52.15 ± 9.82
56.03 ± 8.94
0.021
Weigh (kg) (mean±SD)
62.8 ± 11.04
62.62 ± 8.51
0.92
BMI (kg/m2) (mean±SD)
23.01 ± 3.15
23.19 ± 2.52
0.73
Heigh (m) (mean±SD)
1.65 ± 0.07
1.64 ± 0.05
0.52
Su ge y du a ion (min) (mean±SD)
57.25 ± 42.17
56.97 ± 36.28
0.81
Table 2. Compa ison o CRBD be ween g oup A and B.
CRBD
G oup
A(n=65)
G oup
B(n=64)
To al
P alue
A 0 hou
None
46 (70.77%)
43 (67.19%)
89 (68.99%)
0.927
Mild
11 (16.92%)
11 (17.19%)
22 (17.05%)
Mode a e
7 (10.77%)
9 (14.06%)
16 (12.40%)
Se e e
1 (1.54%)
1 (1.56%)
2 (1.55%)
A 1 hou
None
41 (63.08%)
45 (70.31%)
86 (66.67%)
0.337
Mild
16 (24.62%)
15 (23.44%)
31 (24.03%)
Mode a e
8 (12.31%)
3 (4.69%)
11 (8.53%)
Se e e
0 (0%)
1 (1.56%)
1 (0.78%)
A 2 hou s
None
49 (75.38%)
51 (79.69%)
100 (77.52%)
0.869
Mild
14 (21.54%)
11 (17.19%)
25 (19.38%)
Mode a e
2 (3.08%)
2 (3.13%)
4 (3.10%)
A 6 hou s
None
62 (95.38%)
63 (98.44%)
125 (96.90%)
0.619
Mild
3 (4.62%)
1 (1.56%)
4 (3.10%)
A 24 hou s
None
65 (100%)
64 (100%)
129 (100%)
NA
Table 3. Compa ison o pain be ween g oup A and B.
Pain
G oup
A(n=65)
G oup
B(n=64)
To al
P alue
A 0 hou
Mean ± SD
1.77 ± 1.13
2.05 ± 1.1
1.91 ± 1.12
0.193
Median(25 h-
75 h pe cen ile)
2(1-2)
2(1-2)
2(1-2)
Range
0-6
1-7
0-7
A 1 hou
Mean ± SD
1.52 ± 1.03
1.17 ± 1.29
1.35 ± 1.18
0.013
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
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Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
Median(25 h-
75 h pe cen ile)
2(1-2)
1(0-2)
1(0-2)
Range
0-5
0-5
0-5
A 2 hou s
Mean ± SD
1.06 ± 1.04
0.83 ± 1.05
0.95 ± 1.05
0.064
Median(25 h-
75 h pe cen ile)
1(0-1)
1(0-1)
1(0-1)
Range
0-5
0-5
0-5
A 6 hou s
Mean ± SD
0.34 ± 0.57
0.3 ± 0.46
0.32 ± 0.52
0.91
Median(25 h-
75 h pe cen ile)
0(0-1)
0(0-1)
0(0-1)
Range
0-2
0-1
0-2
A 24 hou s
Mean ± SD
0.06 ± 0.24
0.12 ± 0.33
0.09 ± 0.29
0.217
Median(25 h-
75 h pe cen ile)
0(0-0)
0(0-0)
0(0-0)
Range
0-1
0-1
0-1
Table 4. Compa ison o ad e se e ec s be ween g oup A and B.
Ad e se e ec s
G oup
A(n=65)
G oup
B(n=64)
To al
P alue
Pos -ope a i e
nausea and
omi ing
1 (1.54%)
0 (0%)
1 (0.78%)
1
Agi a ion
1 (1.54%)
2 (3.13%)
3 (2.33%)
0.619
Hallucina ion
1 (1.54%)
0 (0%)
1 (0.78%)
1
Respi a o y
dep ession
0 (0%)
0 (0%)
0 (0%)
NA
Delayed
ex uba ion
0 (0%)
0 (0%)
0 (0%)
NA
Hypo ension/CVS
dep ession
0 (0%)
2 (3.13%)
2 (1.55%)
0.244
Seizu es
0 (0%)
0 (0%)
0 (0%)
NA
LAST
0 (0%)
0 (0%)
0 (0%)
NA
Anuja Pandi , MAR Oncology and Hema ology (2025) 5:09.
Page 9 o 12
Anuja Pandi . (2025). Lidocaine e sus Ke amine o P e en ion o Pos ope a i e Ca he e Rela ed Bladde
Discom o in Pa ien s Unde going T ansu e h al Resec ion o Bladde Tumo : A Randomised Con olled T ial.
MAR Oncology and Hema ology. (2025) 5:09
Fig 2. Compa ison o ca he e ela ed bladde discom o a 0, 1, 2, 6 and 24 hou s be ween g oup A and B
Discussion
Pa ien s unde going in a ope a i e u ina y ca he e isa ion o en complains o CRBD. These symp oms a e
e y simila o symp oms o o e ac i e bladde which migh be due o in olun a y con ac ions o bladde
wall smoo h muscles media ed by musca inic ecep o s.9
Du ieux and Raine sugges ed ha clinically ele an concen a ions o ke amine p o oundly inhibi
musca inic ecep o signaling.10, 11 They also showed ke amine’s e ec as e idenced by educed incidence and
se e i y o CRBD. Se e al s udies suppo he p eemp i e analgesic e ec s o ke amine while some show no
bene i .12-16
Ano he mechanism unde lying he de elopmen o CRBD is local in lamma ion wi h elease o
p os aglandins due o mucosal damage du ing u ina y ca he e isa ion.17 Lidocaine due o i s ac ion on sodium
channel, musca inic and NMDA ecep o s and nocicep i e ansmission pa hways has signi ican
an imusca inic and an iin lamma o y p ope ies. 18
As e idenced by he esul s o ou s udy lidocaine educed he incidence o mode a e o se e e CRBD o he
simila ex en as ke amine. Also, he e was no e idence o lidocaine ela ed side e ec s. P e ious s udies ha e
shown ha lidocaine has a signi ican inhibi o y e ec on musca inic ecep o s, along wi h supp ession o
immune cell–media ed in lamma o y eac ions.19, 20 In addi ion, lidocaine has shown an ihype algesic e ec s
in pa iens unde going lapa oscopic neph ec omy.21, 22
