Effects of different bladder management methods on the quality of life in patients with traumatic spinal cord injury.

STUDY DESIGN: Multi-center, cross-sectional study. OBJECTIVES: To investigate the effects of different bladder management methods on the quality of life (QoL) in patients with spinal cord injury (SCI). SETTING: Turkey. METHODS: Consecutive SCI patients (n=195, 74.4% males), for whom at least 6 months had elapsed since the injury, were included and evaluated in five groups: normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization. The King's Health Questionnaire was used to evaluate the patients' QoL. RESULTS: The bladder management groups were similar regarding age, time elapsed since injury, education level, marital and occupational status. There was no difference among the groups in general health perception, personal relationships and sleep/energy domain scores. While the NSM group had generally the lowest scores, that is, better QoL, the IC-A group had the highest scores, that is, poorer QoL, in most of the domains. When the patients were grouped according to the frequency of urinary incontinence or American Spinal Injury Association Impairment Scale grades, no difference was found in the domain scores of the groups except the symptom severity domain scores. No significant difference was found between paraplegic and tetraplegic patients in the King's Health Questionnaire domains. CONCLUSION: The QoL was notably affected in SCI patients in IC-A group and negative effects on emotional status, physical and social activity limitations were observed, as well.

Perineural meperidine blocks nerve conduction in a dose-related manner: a randomized double-blind study.

BACKGROUND: Meperidine has been shown to exhibit a sensory block in peripheral nerves. However, its motor blockade ability is controversial. The aim of this study was to investigate, electroneurographically, the ability of meperidine to inhibit conduction in both sensory and motor fibres in the ulnar nerve. MATERIALS AND METHODS: The study was conducted in a double-blind, placebo-controlled fashion. Eighteen healthy volunteers were randomized into three groups (Saline, meperidine 1% and meperidine 2%). Three millilitre of the study solution was administered to the ulnar nerve perineurally at the level of the wrist by the guidance of a nerve stimulator. Sensory nerve action potential (SNAP) and compound motor action potential (CMAP) amplitudes were recorded. At least a 20% decrease in the initial response amplitude was accepted as a block. RESULTS: The number of individuals with sensory and motor block with saline, meperidine 1% and meperidine 2% were 0/6, 6/6, 6/6 and 0/6, 5/6, 6/6, respectively (P<0.05). The maximum decrease in the median SNAP and CMAP amplitude values were 4.7% and 8.3% with saline; 38.5% and 46.4% with meperidine 1%; and 100% and 97.8% with meperidine 2%, respectively (P<0.05). Median values for the duration of sensory and motor block with meperidine 1% and meperidine 2% were 45, 52.5 and 30, 32.5 min, respectively. CONCLUSION: Meperidine blocks sensory and motor nerve conduction in a dose-related manner.