Tramadol for the Treatment of Catheter-related Bladder Discomfort

A Randomized Controlled Trial

Shuying Li; Liping Song; Yushan Ma; Xuemei Lin

Disclosures

BMC Anesthesiol. 2018;18(194) 

In This Article

Background

Urinary catheterization is universally used during surgery, though it can cause discomfort postoperatively. The clinical manifestation of catheter-related bladder discomfort (CRBD) may be discomfort in the supra-pubic region, or be similar to an overactive bladder, which manifests as urinary urgency and urinary frequency with or without urge incontinence.[1] CRBD is so distressing that it can increase postoperative agitation and pain, reduce the satisfaction of hospital stay, extend hospital discharge time, and increase the workload of medical staff.[2] As the postoperative incidence of CRBD can be as high as 47–90%, it often requires clinical intervention.[2,3]

Involuntary contraction of the bladder mediated by muscarinic receptors is the main cause of CRBD. A variety of antimuscarinic agents, such as tolterodine, oxybutynin, gabapentin, pregablin, butylscopolamine, paracetamol, ketamine, and dexmedetomidine, have been used to prevent CRBD, with varying degrees of success.[4–11] Nonetheless, even with medication, the incidence of CRBD is still as high as 32–69%; thus urgent treatment is necessary.[6,9,12,13]

There are very few studies on the treatment of CRBD. The therapeutic drugs studied thus far include ketamine, butylscopolamine and hyoscine.[14–17] Tramadol is a centrally acting opioid analgesic that has an antimuscarinic effect. Tramadol pretreatment has been proven to be effective for decreasing the incidence and severity of CRBD.[13] Accordingly, the present study was designed to investigate the efficacy of different dosages of tramadol as urgent treatment for postoperative CRBD and hypotheses that tramadol 1.5 mg/kg was more effective than tramadol 1 mg/kg.

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