Prevention Of Catheter-related Bladder Discomfort Research Articles

Efficacy of Sacral Plexus Block Combined with Dexmedetomidine for Prevention of Catheter-Related Bladder Discomfort in Patients with TURP

This work focused on investigating therapeutic efficacy of sacral plexus block combined with dexmedetomidine in preventing catheter-related bladder discomfort in patients receiving transurethral resection of the prostate. Sixty patients undergoing elective prostatectomy were randomized as group D or group M (n=30 each). Both groups were given dexmedetomidine 0.5 μg/kg 10 min before induction of general anesthesia. The severity score of catheter-related bladder discomfort, Richmond agitation sedation scale, visual analog scale score and adverse events at 30 min (T1), 2 h (T2) and 6 h (T3) postoperatively were recorded. 1 d preoperatively, as well as 1 and 3 d postoperatively, the neuropsychiatric function of patients was tested by mini-mental state examination and the incidence of postoperative cognitive dysfunction was observed. Compared with group D, group M had significantly decreased catheter-related bladder discomfort incidence at T1 and T2 (p<0.05), but with the passage of time, difference in the incidence of catheter-related bladder discomfort of both groups at T3 was of no statistical significance (p>0.05). Compared with group D, the visual analog scale scores of group M at T1, T2 and T3 remarkably decreased (p<0.05). Relative to group D, group M had remarkably reduced agitation scores at T1, T2 and T3 (p<0.05). Differences in the side effects rate and postoperative cognitive dysfunction incidence were not significantly different between both groups (p>0.05). Sacral plexus block combined with dexmedetomidine decreases postoperative catheter-related bladder discomfort rate among transurethral resection of the prostate patients and has good comfort and safety.

Comparison of Different Strategies for Prevention of Catheter-Related Bladder Discomfort: A Randomized Controlled Trial

Comparison of Different Strategies for Prevention of Catheter-Related Bladder Discomfort: A Randomized Controlled Trial

Role of pudendal nerve block for prevention of catheter-related bladder discomfort in male pediatric patients undergoing hypospadias surgery: a prospective randomized control study

BackgroundCatheter-related bladder discomfort (CRBD) is a common distressing symptom complex during the postoperative period, especially after urologic procedures followed by urinary catheterization. The purpose of this study is to evaluate the efficacy of pudendal nerve block and compare it with intravenous butylscopolamine in CRBD prevention in pediatric male patients undergoing hypospadias surgery under general anesthesia.ResultsAfter getting ethical committee clearance and informed written consent, 60 male pediatric patients scheduled for hypospadias repair were enrolled for the study and were randomized using computer-generated random numbers in 2 groups of 30 each: group P (received bilateral pudendal nerve block using 0.25% ropivacaine) and group B (received intravenous butylscopolamine 0.3 mg/kg) 15 min before extubation. The primary outcome was the incidence and severity of CRBD. Visual analog scale (VAS) for postoperative pain, postoperative side effects, the postoperative requirement for tramadol as a rescue treatment for CRBD and fentanyl as rescue analgesia for postoperative pain, and VAS for acceptance of an indwelling urinary catheter were the secondary outcomes. The incidences of CRBD and side effects were analyzed by the chi-square test and severity by Fisher’s exact test. The VAS scale was analyzed by the Mann-Whitney test. A p value of < 0.05 was considered significant.Group P had significantly decreased incidence as well as severity of postoperative CRBD than group B with p < 0.05. The postoperative median VAS score and number of patients requiring fentanyl as rescue analgesics were significantly low in group P in comparison with group B (p < 0.05). The total tramadol requirement at the end of 6 h for CRBD management was also significantly reduced in group P (p < 0.0001).ConclusionsPudendal nerve block seems to be superior to intravenous butylscopolamine in reducing the incidence and severity of CRBD. This study can be extrapolated to other urogenital studies in pediatric patients.

The efficacy of dexmedetomidine for the prevention of catheter-related bladder discomfort: A systematic review and meta-analysis.

Background:The effective therapy to reduce postoperative catheter-related bladder discomfort (CRBD) remained unknown.Objective:We attempted to manage the systematic review and a meta-analysis to clarify the efficacy of dexmedetomidine (DEX) in potential prevention on CRBD.Methods:We performed the meta-analysis on randomized clinical trials (RCTs), and searched the databases from Web of Sciences, Embase and referred Cochrane Library published from October 2016 to September 2020. Data extraction was carefully conducted by 2 authors, respectively. Meta-analysis that was applied synthetically concerns the incidence and severity of CRBD and the treatment effect of DEX on CRBD.Results:We acquired 5 RCTs with interventions of DEX on CRBD. Meta-analysis showed DEX has significantly reduced the incidence and severity of CRBD compared with control at 0 hour (risk ratios [RR] = 0.40, 95% CI = 0.53–0.29, P < .01), 1 hour (RR = 0.44, 95% CI = 0.34–0.57, P < .01), and 2 hours (RR = 0.43, 95% CI = 0.32–0.58, P < .01) and 6 hours (RR = 0.43, 95% CI = 0.29–0.63, P < .01). DEX was also associated with lower incidence of moderate to severe CRBD at 0, 1, and 6 hours after surgery. There were no significant differences in adverse events other than bradycardia, hypotension, and hypertension.Conclusion:The 5 RCTs showed great effectiveness in reducing the incidence and severity of the early and later postoperative CRBD. Meta-analysis showed that DEX interventions were useful in preventing the early and later postoperative CRBD without significant side effects.

Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery

Introductions: Catheter-related bladder discomfort (CRBD) is common in patients with urinary catheterization. Centrally acting intravenous opioid like Tramadol inhibits detrusor activity and incidence of CRBD. Present study aims to analyze efficacy of intravenous (IV) Tramadol in prevention of CRBD in patients undergoing upper urinary tract surgery. &#x0D; Methods: Adult patients undergoing elective open upper urinary tract surgeries at Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal, over a period of six months, requiring urinary catheterization were randomly divided into Control (C) and Tramadol (T) groups. After general anesthesia, patients in T-group received IV Tramadol 1.0 mg/kg and C-group received normal saline 30 minutes before extubation. In post-operative ward, CRBD was graded as mild, moderate or severe at 0, 1, 2 and 6 hours. Post-operative Ramsay sedation score and nausea vomiting were compared in two groups. &#x0D; Results: There were total 70 patients, 35 in each of groups-T and C. Incidence of CRBD in T-group was significantly low compared to the C-group at all points of evaluation (p&lt;0.05). Postoperative sedation score, analgesic requirement and nausea vomiting were not significantly different in two groups. &#x0D; Conclusions: Intravenous Tramadol administered before extubation in upper urinary tract surgery reduces the incidence of CRBD.

Efficacy of trospium for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study

BackgroundCatheter-related bladder discomfort (CRBD) is a frequent complaint after awakening from anesthesia in patients receiving perioperative bladder catheterization. Overactive bladder (OAB) and CRBD show similar symptoms; thus, drugs used for the management of OAB influence symptoms of CRBD. Trospium chloride has been found effective in managing resistant cases of OAB. We evaluated the efficacy of oral trospium on CRBD in the postoperative period.MethodsSixty-four male and female adult patients, with planned spinal surgery and requiring urinary bladder catheterization, were randomly divided into two groups of 32 each. Group T patients received 60 mg extended-release oral trospium (extended-release) 1 h before induction of anesthesia and Group C patients received a similar-looking placebo. The anesthetic technique was identical in both groups. The CRBD score was evaluated in the postoperative ward using a 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe). Readings were recorded on arrival (0 h), and 1 h, 2 h, and 6 h postoperatively. All patients received fentanyl for postoperative pain relief.ResultsThe incidence of CRBD was significantly higher in Group C than in Group T at 0 h (66% vs. 22%, P = 0.001) and 1 h postoperatively (72% vs. 28%, P = 0.001). The incidence of moderate to severe CRBD was higher in Group C at postoperative 2 h (82% vs. 14%, P = 0.004). There was no significant difference in postoperative fentanyl requirements.ConclusionsPretreatment with 60 mg extended release trospium reduced the incidence and severity of CRBD in the early postoperative period.

The Efficacy of Intraoperative Ketamine-Haloperidol for Prevention of Catheter-related Bladder Discomfort After Lumbar Spinal Stenosis Surgery.

ObjectivesCatheterization of urinary bladder during surgery frequently leads to agitation of the patient in the recovery room, especially in those patients who remain catheterized after gaining consciousness. We hypothesized that administration of a combination of ketamine-haloperidol (KH) before urinary catheterization would reduce the incidence of catheter-related bladder discomfort (CRBD) while reducing some adverse effects of ketamine in the postoperative period.MethodsA total of 119 male patients who underwent lumbar spinal stenosis surgery were randomized into three groups. The KH group consisted of 39 patients who received KH just before urinary catheterization. The second arm of the study including 40 patients who received pethidine-haloperidol (PH). The control (C) group consisted of 40 patients who received normal saline as a placebo. We sought to determine the incidence and severity of CRBD at arrival in recovery and one, six, and 24 hours after.ResultsThe incidence of CRBD upon arrival in the recovery room was 17.9% in the KH group, and 52.5% and 55% in the PH and C groups, respectively. The incidence of CRBD was significantly lower in the KH group at arrival in the recovery room. The severity of CRBD was lower in the KH group at one and six hours of surgery (p < 0.007). There was no significant difference 24 hours after surgery.ConclusionsIntravenous administration of KH before urinary catheterization effectively decreases the incidence and severity of postoperative CRBD while reducing adverse effects attributed to ketamine.

Efficacy of parecoxib for the prevention of catheter-related bladder discomfort after transurethral resection of bladder

Objective The aim of this study was to assess the prevention profiles of parecoxib on catheter-related bladder discomfort (CRBD) after transurethral resection of bladder tumor(TURBT). Methods Fifty-six male adult patients undergoing transurethral resection of bladder tumor were enrolled. Induction and maintenance of anesthesia were standardized. Patients were randomly divided into two groups according to the random number table method that received either intravenous 0.9% NaCl solution[control group (group C)] or parecoxib (40 mg) (group P) at 10 min before the end of the operation. The incidence and severity of CRBD, postoperative pain, Ramsay scores, patient satisfaction, postoperative additional drugs and adverse effects were assessed at 5 min (T1), 1 h (T2), 6 h (T3) and 12 h (T4) after administration of the parecoxib by another observer who does not know research grouping situation. Results The incidence of CRBD in group P at T1, T2 and T3 was significantly lower than that in group C (89.3% vs 46.4%, 89.3% vs 35.7%, 67.9% vs 39.3%)(P 0.05). Conclusions Not only can a single intravenous injection of parecoxib 40 mg at the end of surgery effectively reduce the incidence and severity of postoperative CRBD in patients with TURBT, but also has certain analgesic effect without causing serious adverse reaction. Key words: Parecoxib; Catheter-related bladder discomfort; Transurethral resection of bladder tumor

Efficacy and safety of Parecoxib for prevention of catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor: Prospective randomised trial.

Background and Aims:Catheter-related bladder discomfort (CRBD) is the urge to void or discomfort in the suprapubic region secondary to an indwelling urinary catheter. We aimed to evaluate the safety and efficacy of single-dose of intravenous parecoxib in reducing the incidence and severity of CRBD in patients undergoing transurethral resection of bladder tumor (TURBT).Methods:Sixty-one adult patients, American Society of Anesthesiologists physical status I or II, undergoing elective TURBT under spinal anaesthesia, were randomly allocated to receive 40 mg of IV parecoxib (group P; n = 29) or an equal volume of normal saline (control group C; n = 32). CRBD was graded as none, mild, moderate, and severe. Between-group comparisons were made for the incidence and severity of CRBD, postoperative Visual analog scales (VAS), rescue analgesia equirements, and occurrence of adverse events. Statistical analysis done with the Mann–Whitney U-test and Fisher's Exact Test. A P value of ≤ 0.05 was considered statistically significant.Results:Parecoxib significantly reduced the incidence and severity of CRBD at 2, 4, 6, and 12 hours postoperatively compared to placebo (P < 0.05). Median pain VAS scores were lower in the P group at all times except the first hour. Rescue analgesia was given to more patients in group C (16/32, 50%) than in group P (1/29) (P < 0.001). None of the patients who received parecoxib experienced an adverse event.Conclusion:A single intravenous injection of parecoxib is safe and effective in decreasing the incidence and severity of CRBD in patients undergoing TURBT.Trial Registration Identifier:NCT02729935(www.clinicaltrials.gov).

Evaluation of hyoscine N-butyl bromide efficacy on the prevention of catheter-related bladder discomfort after transurethral resection of prostate: a randomized, double-blind control trial.

Transurethral resection of prostate (TURP) is the most common treatment for benign prostatic hyperplasia (BPH). Urinary tract catheter is inserted post-operatively which results in catheter-related bladder discomfort (CRBD) in many patients. The purpose of this study was to assess the preventive effect of hyoscine N-butyl bromide on CRBD caused by a urinary tract catheter after TURP surgery in patients with BPH. Twenty-four and twenty-six patients in the treatment and control groups were enrolled, respectively. At the end of the surgery, slow intravenous injection of 20mg hyoscine N-butyl bromide was administered to the patients of treatment group. The severity of CRBD was followed up at five different time periods and up to 2h after surgery. On arrival to PACU and after 30min of injection, statistically significant less CRBD was seen in the treatment group comparing to the control group (P≤0.05 and P≤0.007). The total utilized meperidine dose during PACU stay and the time to discharge for the intervention group were significantly lower than those for the control group (P≤0.0001) with no significant difference in adverse effects (P>0.05). Hyoscine N-butyl bromide could reduce the severity of CRBD related to TURP in patients with BPH and their need for analgesic consumption either. It shortened the length of stay in the recovery room. Regarding its availability and low cost, it can be an effective pain relief drug for CRBD discomfort related to TURP in BPH patients.

Strategies for the prevention of catheter-related bladder discomfort: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials.

Background:The ideal measures to prevent postoperative catheter-related bladder discomfort (CRBD) remain unestablished. We conducted the systematic review and meta-analysis to clarify the significance of potential interventions.Methods:We followed the Preferred Reporting Items for Systematic review and Meta-Analysis statement guidelines, and searched databases from MEDLINE, EMBASE, and referred Cochrane Library for randomized clinical trials (RCTs) published before December 2014. Reference lists from reviews or related articles were screened and checked for the related RCTs. Data extraction was performed carefully by 2 authors, respectively, and methodological quality was assessed by scoring system. Meta-analysis was applied for studies using the similar strategies or same reagents on the similar participants focused on CRBD. The primary outcome measure was the incidence of postoperative CRBD.Results:We identified 8 RCTs with interventions ranging from perioperative managements to pharmacological or multicomponent interventions. Meta-analysis showed ketamine was associated with less incidence of CRBD compared with placebo (pool risk ratio [RR] = −0.75, 95% confidence interval [CI] = 0.17–3.44, P < 0.01) at 0 hour, 1 hour (RR = −0.26, 95%CI = −0.38 to −0.13, P < 0.01), and 2 hours (RR = 0.31, 95%CI = 0.17–0.55, P < 0.01) and 6 hours (RR = 0.23, 95% CI = 0.11–0.49, P < 0.01) after operation. Oxybutynin did not affect the incidence of CRBD (RR = 0.46, 95%CI = 0.20–1.03, P = 0.06). Anticholinergic drugs also lower the incidence of CRBD at 0 hour (RR = 0.52, 95% CI = 0.38–0.71, P < 0.01), 1 hour (RR = 0.66, 95% CI = 0.51–0.86, P < 0.01), 2 hours (RR = 0.62, 95% CI = 0.46–0.84, P < 0.01), and 6 hours (RR = 0.56, 95%CI = 0.38–0.81, P < 0.01) postoperatively. Tramadol and gabapentin were also useful in lower the incidence and severity of CRBD in a RCT with 50 patients.Conclusion:The included studies showed great effectiveness in incidence of postoperative CRBD. Meta-analysis supported that ketamine, oxybutynin, and anticholinergic reagents interventions were useful in preventing postoperative catheter-related bladder discomfort.

Comparison of intravenous tramadol and ketamine for prevention of catheter-related bladder discomfort after laparoscopic surgery: a randomized, placebo-controlled, double-blind study

Background: Catheter-related bladder discomfort (CRBD) is a distressing symptom after anesthesia. Objectives: To compare the efficacy of tramadol and ketamine to prevent CRBD after laparoscopic surgery. Methods: After registration with the Thai Clinical Trial Registry (TCTR20140220001), we conducted a randomized controlled trial in 210 patients aged 18–70 years with American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic surgery requiring bladder catheterization. These patients were randomly allocated into 1 of 3 groups: Group T received intravenous (i.v.) tramadol 1.5 mg/kg, Group K received i.v. ketamine 0.5 mg/kg, and Group P received i.v. saline as a placebo before catheterization. Patients received i.v. morphine for postoperative pain control. An anesthesiologist blinded to the randomization evaluated postoperative and CRBD pain severity using visual analog scales (VAS). The cumulative postoperative and CRBD pain was calculated by multiplying mean VAS scores by the hours of assessment. Results: Groups T and K had significantly less cumulative CRBD pain compared with placebo (P = 0.04 and 0.001, respectively). Cumulative postoperative pain, total 24-h morphine consumption, and adverse effects were comparable between groups. Group T had a significantly lower incidence of shoulder pain (7/67, 10%) than Group K (21/70, 30%), and Group P (24/70, 34%) 24 h after surgery (P = 0.006 and 0.001, respectively). Conclusions: Tramadol 1.5 mg/kg and ketamine 0.5 mg/kg administered i.v. before bladder catheterization are both effective in reducing the 24-h cumulative postoperative CRBD after laparoscopic surgery without significant adverse effects. Tramadol also decreases the incidence of postlaparoscopy shoulder pain. Keywords: Catheter-related bladder discomfort, ketamine, laparoscopic surgery, laparoscopy, pain, prevention, tramadol

Dorsal Penile Nerve Block With Ropivacaine-Reduced Postoperative Catheter-Related Bladder Discomfort in Male Patients After Emergence of General Anesthesia: A Prospective, Randomized, Controlled Study.

Catheter-related bladder discomfort (CRBD) is a distressing symptom complex after surgery, especially in male patients who have had urinary catheterization under general anesthesia. In this prospective, randomized, controlled trial, we compared dorsal penile nerve block (DPNB) with 0.33% ropivacaine with intravenous tramadol 1.5 mg kg−1 in prevention of CRBD, as well as the incidences of postoperative side effects.Fifty-eight male patients aged 18 to 50 years, undergoing elective liver surgery and limb surgery with urinary catheterization, were enrolled and divided randomly into 2 groups. In the DPNB group, patients were given dorsal penile nerve block with 15 mL of 0.33% ropivacaine, and in the tramadol intravenous administration (TRAM) group, patients were given 1.5 mg kg−1 tramadol after the completion of surgery before extubation. The primary outcome was the incidence of CRBD, and the secondary outcomes included the severity of CRBD, postoperative side effects, postoperative pain, and the acceptance of urinary catheterization. Patients were evaluated upon arrival to postanesthetic care unit (PACU), at 0.5, 1, 2, 4, and 6 hours after patients’ arrival in the PACU for outcomes.The incidence of CRBD was significantly lower in the DPNB group than in the TRAM group, either upon arrival to PACU (10.3% vs 37.9%, P = 0.015), or at 0.5 hours (3.4% vs 34.5%, P = 0.003), 1 hours (3.4% vs 37.9%, P = 0.001), 2 hours (6.9% vs 34.5%, P = 0.010), and 4 hours (6.9% vs 27.6%, P = 0.039) after patients’ arrival in PACU. Compared with the TRAM group, the severity of postoperative CRBD upon arrival to PACU (P = 0.011) and at 0.5 hours (P = 0.005), 1 hours (P = 0.002), 2 hours (P = 0.005), 4 hours (P = 0.017), and 6 hours (P = 0.047) after patients’ arrival in PACU were all significantly reduced in the DPNB group. The incidences of postoperative nausea, vomiting, dizziness, and sedation were decreased significantly in the DPNB group compared with the TRAM group (P < 0.05). The acceptance of urinary catheterization was 93.1% (27/29 patients) in the DPNB group and 58.6% (17/29 patients) in the TRAM group, respectively (P < 0.001).DPNB with ropivacaine has a better effect for CRBD reduction and less side effects than intravenous tramadol administration.The trial has been registered at www.clinicaltrials.gov (NCT01721031).

Evaluation of efficacy of amikacin for attenuation of catheter-related bladder discomfort in patients undergoing percutaneous nephrolithotomy: A prospective, randomized, placebo-controlled, double-blind study.

Context:Catheter-related bladder discomfort (CRBD) is the most distressing symptom in patients due to intraoperative urinary catheterization. Amikacin significantly inhibits detrusor contraction evoked by prejunctional stimulation.Aims:The aim of this study is to evaluate the efficacy of amikacin in prevention of CRBD in patients undergoing percutaneous nephrolithotomy.Settings and Design:Study areas were operation theater and postanesthesia care unit of the Department of Anesthesiology, SGPGIMS, Lucknow.Subjects and Methods:One hundred adult patients of either sex were randomly assigned into two groups of fifty each. Patients in control group received normal saline whereas patients in amikacin group received amikacin 10 mg/kg just before induction. Grading of CRBD was done as none, mild, moderate, and severe by a blinded observer at 0, 1, 6, 12, and 24 h after surgery.Statistical Analysis Used:Data were analyzed using Student's t-test and Chi-square test among groups. Incidence of CRBD was compared with Chi-square test whereas severity was analyzed by the test of proportions (Z-test). Visual analog score was compared using Mann–Whitney U-test for surgical site pain.Results:Incidence of CRBD in control group was 66% as compared to 44% observed in amikacin group (P < 0.05). During intergroup comparison at different time points, incidence of CRBD was reduced at 1 and 6 h in the amikacin group (P < 0.05). Significant reduction in the severity of CRBD (moderate) was also observed at 1 h in the amikacin group (P < 0.05). At rest of the time points, there was no significant difference.Conclusions:Amikacin can significantly reduce the incidence and severity of CRBD in the first few hours after surgery.

Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery.

To investigate the incidence and risk factors for emergence agitation in the postanaesthetic care unit (PACU), in adult patients undergoing urological surgery. Medical records were retrospectively reviewed. Preoperative, intraoperative and postoperative variables were evaluated. Emergence agitation was defined as a Riker sedation-agitation score ≥ 5. Logistic regression analysis was used to determine independent risk factors for emergence agitation. Emergence agitation was observed in 48/488 (9.8%) patients. Chronic lung disease (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.03, 7.17), duration of surgery (OR 1.01, 95% CI 1.00, 1.01), history of social drinking (OR 2.48, 95% CI 1.25, 4.93), postoperative pain score (OR 1.32, 95% CI 1.14, 1.53), voiding urgency (OR 2.20, 95% CI 1.01, 4.77) and presence of gastric tube (OR 2.85, 95% CI 1.07, 7.54) were independent risk factors for emergence agitation. Adequate postoperative pain management and prevention of catheter-related bladder discomfort may be helpful in reducing the incidence of emergence agitation in urology patients.

The efficacy of pregabalin for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled double-blind study.

The present study evaluated the efficacy of preoperative pregabalin for prevention of catheter-related bladder discomfort. Prospective, randomized, placebo controlled, double blinded study. Sixty patients of either sex undergoing elective spine surgery and requiring urinary bladder catheterization were randomly assigned to two groups. The patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and the patients in Group C (control group) received placebo. Anesthesia technique was identical in both the groups. Catheter-related bladder discomfort (CRBD) was evaluated on a 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe), on arrival (0 h) and again at 1, 2, and 6 h postoperatively. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. The incidence of CRBD was significantly less in the pregabalin group compared with the control group at all time intervals (P < 0.05). The severity of CRBD was reduced in the pregabalin group compared with the control group at all time intervals except 6 h. The postoperative consumption of fentanyl was significantly less in group P, while the sedation score was significantly higher in the group P compared to group C. Pretreatment with pregabalin 150 mg prevents CRBD and also decreases postoperative fentanyl consumption. ClinicalTrials.gov identifier: (ref: CTRI/2013/11/004170).

Comparison of dorsal penile nerve block plus ring block with 0.33% ropivacaine and intravenous tramadol for prevention of catheter-related bladder discomfort

Comparison of dorsal penile nerve block plus ring block with 0.33% ropivacaine and intravenous tramadol for prevention of catheter-related bladder discomfort

Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study

BackgroundCatheter-related bladder discomfort (CRBD) is defined as an urge to void or discomfort in the supra-pubic region; reported postoperatively in patients who have had urinary catheterization intra-operatively. We have evaluated tramadol, a centrally acting opioid analgesic with muscarinic receptor antagonist properties for prevention of CRBD. MethodsFifty-four adults (18–60 yr), ASA physical status I and II of either sex, undergoing elective percutaneous nephro-lithomy were randomly divided into two groups of 27 each. Control (C) group received normal saline (NS; 2 ml), whereas Tramadol (T) group received tramadol 1.5 mg kg−1. All medications were diluted in 2 ml NS and administered 30 min before extubation. Intra-operatively, urinary catherization was performed with a 16 Fr Foley's catheter, and the balloon was inflated with 10 ml distilled water. The CRBD was assessed at 0, 1, 2, and 6 h after patient's arrival in the post-anaesthesia care unit along with total postoperative fentanyl requirement. Severity of CRBD was graded as none, mild, moderate and severe. Data were analysed by one-way anova, Z-test, and Fisher's exact test. P<0.05 was considered significant. ResultsIncidence and severity of CRBD was reduced in T group compared with C group at all time points (P<0.05). Postoperative pain as assessed by visual analogue scale and total postoperative fentanyl requirement (μg kg−1) was also reduced in the T group [176 (sd 26.5)] compared with C group [210 (34.6)] (P<0.05). ConclusionsTramadol 1.5 mg kg−1 administered i.v. 30 min before extubation decreases the incidence and severity of CRBD and postoperative fentanyl requirement.

An Evaluation of the Efficacy of Gabapentin for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study

Catheter-related bladder discomfort (CRBD) secondary to catheterization of urinary bladder is distressing. In the present study, we evaluated gabapentin for preventing CRBD. One-hundred and eight consecutive adult patients, ASA physical status I and II, of either sex, undergoing elective percutaneous nephrolithotomy were randomized into two groups of 54 each. Group control: placebo and group G gabapentin: gabapentin 600 mg. Drugs were administered orally 1 h before surgery. After induction of anesthesia, patients were catheterized with a 16F Foley catheter and the balloon was inflated with 10 mL normal saline. In the postanesthesia care unit, the incidence and severity (mild, moderate, and severe) of CRBD were assessed on arrival (0) and at 1, 2, and 6 h. Gabapentin reduced the incidence of CRBD to 50% (27 of 54) compared with 80% (43 of 54) observed in the control group (P < 0.05). Gabapentin also reduced the severity of CRBD and postoperative pain as observed by a reduction in the number of patients requiring any fentanyl and the total fentanyl consumption postoperatively (P < 0.05). Gabapentin (600 mg) administered orally 1 h before surgery reduced the incidence and severity of CRBD, postoperative pain, number of patients requiring fentanyl and postoperative total fentanyl requirement.

The Efficacy of Tolterodine for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study

Bladder discomfort secondary to an indwelling urinary catheter is distressing, particularly for patients awakening from anesthesia. We sought to discover the incidence and severity of bladder discomfort in patients who were catheterized intraoperatively and to evaluate the efficacy of tolterodine, a pure muscarinic receptor antagonist, in preventing this. Two-hundred-fifteen consecutive adult patients, ASA physical status I and II, either sex, undergoing urologic surgery requiring bladder catheterization were enrolled. Group C (control, n = 165) received placebo and group T (tolterodine, n = 50) received tolterodine 2 mg. Drugs were administered orally 1 h before surgery. After induction of anesthesia, patients were catheterized with a 16F Foley catheter and the balloon was inflated with 10 mL of normal saline. In the postanesthesia care unit, bladder discomfort was assessed on arrival (0), 1, 2 and 6 h. Severity of bladder discomfort was graded as mild, moderate, and severe. Bladder discomfort observed in group C was 55% (91 of 165). Tolterodine reduced both the incidence 36% (18 of 50) and severity of bladder discomfort (P < 0.05). Bladder discomfort secondary to an indwelling urinary catheter is distressing to patients. In the present study, we observed that tolterodine (2 mg), a competitive muscarinic receptor antagonist administered 1 h before surgery, reduced both the incidence and severity of bladder discomfort secondary to bladder catheterization.