Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study

Abstract

Background The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether intravesical dexmedetomidine instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia. Methods This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine group and 83 in the control group. Dexmedetomidine group patients received intravesical instillation of the drug 0.5 μg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. CRBD scores and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups. Results CRBD scores and urethra pain NRS scores after 30 min of intravesical dexmedetomidine instillation to 24 h post-operation were significantly lower than the control group (p < 0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p < 0.001). No differences were detected in Steward score out of PACU (p = 0.213) and from the time of the end of operation to fully awake (p = 0.417). Conclusion Intravesical dexmedetomidine instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia. Trial registration Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018.

The Impact of Dexmedetomidine Doses on Postoperative Cognitive Dysfunction and Inflammatory Response in Elderly Female Patients Undergoing Laparoscopic Cholecystectomy

“…Thus, we hypothesize that Dex can reduce the incidence of POCD in elderly patients undergoing LC and enhance postoperative cognition. However, Turan et al [25] argue that perioperative use of Dex does not signi cantly improve postoperative cognition in the elderly, which may be related to the age of the study subjects, the dosage and timing of Dex administration, and the lack of a loading dose. Our trial used a loading dose method, achieving a steady-state plasma concentration earlier, which could more fully exploit the advantages of Dex.…”

Effect of magnesium sulfate perioperative infusion on postoperative catheter-related bladder discomfort in male patients undergoing laparoscopic radical resection of gastrointestinal cancer: a prospective, randomized and controlled study

“…The first mechanism is that the catheter causes activation of urethral M receptors, which in turn leads to the contraction of urethral smooth muscle, resulting in CRBD [ 4 , 22 ]. Therefore, dexmedetomidine, tolterodine, solifenacin, butylscopolamine, and trospium have been studied for the prevention of CRBD with varying success rates [ 11 , 23 – 26 ], and some analgesics such as tramadol are used based on this mechanism [ 12 , 18 ]. Another mechanism is the release of prostaglandins, such that many anti-inflammatory drugs, including lidocaine and ketorolac, have been reported for the prevention of CRBD [ 4 , 13 ].…”

“…It can exacerbate postoperative pain and restlessness, leading to serious adverse events. Therefore, clinical staff must focus on the early prevention and active treatment of CRBD [ 11 – 13 ]. Presently, a regimen for the management of CRBD is not yet established.…”

Targeted hollow pollen silica nanoparticles for enhanced intravesical therapy of bladder cancer

“…After clipping the intravesical instillation catheter for 1 h, the catheter was unclipped to allow spontaneous discharge of PBS of MB49 cells. 27 After 14 days, 28 tumor formation in the bladder of mice was identified by magnetic resonance imaging (MRI) (Philips MR Ingenia Elition 3.0T). T2-wi TSE sequences were used for MRI imaging, and the specific parameters were as follows: TR/TE = 3000 ms/90 ms, matrix size = 124 × 105, FOV = 50 × 50 mm, voxel = 0.4 × 0.5 × 0.5.…”