The effect of intraoperative dexmedetomidine on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumour resection A double-blind randomised study

BACKGROUNDCatheter-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.OBJECTIVETo determine the effect of intraoperative dexmedetomidine administration on the incidence of CRBD.DESIGNA double-blind, placebo-controlled, randomised study.SETTINGA tertiary care teaching hospital.PATIENTSOne-hundred and nine patients undergoing transurethral bladder tumour excision (TURB).INTERVENTIONSPatients were randomly allocated to two groups: control group (n=55) received placebo and dexmedetomidine group (n=54) received intraoperative dexmedetomidine (1gkg(-1) loading dose followed by 0.5gkg(-1)h(-1)continuous infusion).MAIN OUTCOME MEASURESThe incidence and severity (mild, moderate, severe) of CRBD assessed at 0, 1, 6 and 24h postoperatively.RESULTSThe incidence of CRBD was significantly higher in the control group at 0 (78 vs. 50%; P=0.004), 1 (86 vs. 57%; P=0.002) and 6h (82 vs. 63%; P=0.047) postoperatively. The incidence of moderate to severe CRBD was higher in the control group at 0 (38 vs. 11%; P=0.002) and 1h (29 vs. 7%; P=0.006) postoperatively. The number of patients having CRBD treated with tramadol was higher in the control group (24 vs. 12; P=0.006). The mean end-tidal desflurane concentration during the surgery was higher in the control group (4.5 vs. 3.9%; P=0.04). The postoperative pain score (numerical rating scale: 0 to 10) was higher in the control group at 0 (4.6 vs. 2.7; P=0.002), and 1h (3.8 vs. 2.7; P=0.041). The number of patients treated with opioids was higher in the control group (21 vs. 8; P=0.011).CONCLUSIONIntraoperative dexmedetomidine administration decreased the incidence and severity of early postoperative CRBD as well as intraoperative desflurane and postoperative opioid requirements in patients undergoing TURB.TRIAL REGISTRATION IDENTIFIERNCT01991223 (www.clinicaltrials.gov).