Use of Dorsal Penile nerve block with Bupivacaine for the prevention of catheter related bladder discomfort for patients in ICU.

Catheter related Bladder discomfort (CRBD) due to an indwelling urinary catheter is most common distressing complex of symptoms such as burning sensation, an urge to void, stabbing pain and discomfort in the Supra-pubic region, all thought to be due to friction between the catheter and the urothelium.

There is a wide incidence of CRBD in patients who have urinary catheterization. CRBD commonly causes patient agitation and is accompanied by behavioural responses that may include loud complaining and attempts to remove the urinary catheter. In addition CRBD may result in exacerbated pain and increased urinary tract infections, complications and prolonged hospital stay.

The mechanism of CRBD is mediated by type 3 muscarinic receptor  activation, which increases acetylcholine release and then causes the detrusor muscles of the bladder to contract involuntarily. The technique of dorsal penile nerve block has been applied clinically in penile surgeries for decades and satisfactory pain relief effect could be achieved.

The incidence and the severity of CRBD will be assessed according to the following scaling system; No CRBD indicates that there are no complaints of CRBD at all; Mild indicates that complaints of CRBD exists only if the patient was asked about it; Moderate indicates that the patient complain of CRBD spontaneously; and Severe indicates that the CRBD causes a spontaneous behavioural responses such as flailing limb, strong vocal response, or attempt to pull out catheter. Pain will be assessed by Numerical analogue scoring.