Discussion
postoperative pain, pain, IC/BPS, muscle spasms, bladder rupture
BLADDER RUPTURE
In this study, we demonstrated that SA has some advantages over GA in preventing abrupt hemodynamic responses during bladder hydrodistention in patients with IC/BPS. In particular, an SBP increase of more than 20% from baseline was only observed in the GA group. Moreover, the number of patients requiring rescue vasopressors was smaller and postoperative pain scores in PACU were lower in the SA group.In healthy individuals, as the hydrostatic pressure rises during bladder filling, afferent Aδ fibres in the hypogastric and pelvic nerves increase their activity to stimulate the sympathetic nervous system, resulting in relaxation of the bladder smooth musclesHRV is a widely used physiologic test to evaluate the imbalances within the autonomic nervous system. According to the results of the present study, measures of HRV did not differ between the groups before bladder hydrodistention. However, RMSSD after bladder hydrodistention was significantly lower in the GA group. RMSSD reflects the vagal-mediated changes in HRPostoperative pain increases recovery times and the length of hospital stays, and lowers patient satisfactionAlthough spinal anaesthesia has several advantages over general anaesthesia during bladder hydrodistention, there are possible caveats to spinal anaesthesia; particularly, bladder rupture may occur due to adductor muscle spasms triggered by the stimulation of the obturator nerve during electrocautery for coagulation. A previous study observed an obturator reflex in 20% of patients under GA; such a case was, however, not observed in this studyThis study has several limitations. First, we determined the remifentanil concentration (4–6 ng/mL) prior to bladder hydrodistention in the GA group based on the remifentanil concentration required for preventing hemodynamic responses to tracheal intubation in a previous studyIn conclusion, we found that spinal anaesthesia has some advantages over general anaesthesia for bladder hydrodistention in terms of preventing an abrupt increase in SBP and controlling pain in the PACU.