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

Abstract

Background: Catheter-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. Methods: Sixty-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. Results: The 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. Conclusions: Pretreatment with 60 mg extended release trospium reduced the incidence and severity of CRBD in the early postoperative period.

Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

“…Although literature supports the use of these medications perioperatively to reduce catheter-related bladder discomfort for patients undergoing urologic surgery patients, they have undesirable anticholinergic adverse effects and can contribute to delirium. 57,58 For this reason, all medications in this class are considered cautionary in older patients. 59,60…”

Catheter-Related Bladder Discomfort: How Can We Manage It?

“…CRBD prevalence and severity were significantly less in the solifenacin and darifenacin groups compared with the placebo group at all time intervals (P <0.05). Solifenacin and darifenacin both reduced CRBD without clinically significant side effects [ 14 ].…”

Comparison of intravenous lidocaine and dexmedetomidine infusion for prevention of postoperative catheter-related bladder discomfort: a randomized controlled trial

“…The mechanism of CRBD is caused by involuntary contraction of the bladder, as mediated by muscarinic receptors, especially the subtype M 3 receptor [ 4 ]. Various agents have been employed to manage CRBD, with varying degrees of success, including tolterodine, oxybutynin, butylscopolamine, paracetamol, gabapentin, pregablin, ketamine, tramadol, dexmedetomidine, darifenacin and solifenacin [ 5 – 18 ]. Although most of these drugs are helpful for managing CRBD, they also have many side effects, such as dry mouth, sedation, nausea, and vomiting.…”