The effect of intraoperative dexmedetomidine on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumour resection

Abstract

BACKGROUND Catheter-related bladder discomfort (CRBD) due to an indwelling urinary catheter causes postoperative distress. Dexmedetomidine is used as an anaesthetic adjuvant during general anaesthesia and has an antimuscarinic effect, which may be beneficial for the prevention and treatment of CRBD. OBJECTIVE To determine the effect of intraoperative dexmedetomidine administration on the incidence of CRBD. DESIGN A double-blind, placebo-controlled, randomised study. SETTING A tertiary care teaching hospital. PATIENTS One-hundred and nine patients undergoing transurethral bladder tumour excision (TURB). INTERVENTIONS Patients were randomly allocated to two groups: control group (n¼55) received placebo and dexmedetomidine group (n¼54) received intraoperative dexmedetomidine (1mgkg 1 loading dose followed by 0.5mgkg 1 h 1continuous infusion). MAIN OUTCOME MEASURES The incidence and severity (mild, moderate, severe) of CRBD assessed at 0, 1, 6 and 24 h postoperatively. RESULTS The incidence of CRBD was significantly higher in the control group at 0 (78 vs. 50%; P¼0.004), 1 (86 vs. 57%; P¼0.002) and 6 h (82 vs. 63%; P¼0.047) postoperatively. The incidence of moderate to severe CRBD was higher in the control group at 0 (38 vs. 11%; P¼0.002) and 1 h (29 vs. 7%; P¼0.006) postoperatively. The number of patients having CRBD treated with tramadol was higher in the control group (24 vs. 12; P¼0.006). The mean end-tidal desflurane concentration during the surgery was higher in the control group (4.5 vs. 3.9%; P¼0.04). The postoperative pain score (numerical rating scale: 0 to 10) was higher in the control group at 0 (4.6 vs. 2.7; P¼0.002), and 1 h (3.8 vs. 2.7; P¼0.041). The number of patients treated with opioids was higher in the control group (21 vs. 8; P¼0.011). CONCLUSION Intraoperative dexmedetomidine administration decreased the incidence and severity of early postoperative CRBD as well as intraoperative desflurane and postoperative opioid requirements in patients undergoing TURB.