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. 2023 Feb;67(Suppl 2):S81-S92.
doi: 10.4103/ija.ija_200_22. Epub 2023 Feb 22.

Pharmacological interventions for reducing catheter-related bladder discomfort in patients undergoing elective surgeries under general anaesthesia: A systematic review and meta-analysis

Roopesh Ramesh  1 , Ankur Mittal  2 , Sanjay Agrawal  1
Affiliations

Pharmacological interventions for reducing catheter-related bladder discomfort in patients undergoing elective surgeries under general anaesthesia: A systematic review and meta-analysis

Roopesh Ramesh et al. Indian J Anaesth. 2023 Feb.

Abstract

Background and aims: Catheter-related bladder discomfort (CRBD) is identified as a major concern after surgery as it can lead to increased morbidity and prolonged hospital stay. A suitable agent to prevent and treat postoperative CRBD is not yet established, and the literature is scarce in this regard. So, we aimed to find the efficacy of various drugs in preventing CRBD after elective surgery.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the study, and electronic databases like PubMed Central, Cochrane database and Embase were searched. The methodological quality of selected studies was assessed by the Cochrane Collaboration risk of bias tool. Review Manager 5.4.1 was used for statistical analysis.

Results: The meta-analysis revealed that antimuscarinic agents were able to lower the incidence of CRBD significantly at 0 hour, 1 hour, 2 hours and 6 hours (P < 0.01) after the surgery. Tramadol was effective at 1 hour, 2 hours and 6 hours postoperatively (P < 0.01), whereas ketamine was effective at 2 and 6 hours (P < 0.01) postoperatively. Antiepileptic drugs (pregabalin and gabapentin) were able to lower the incidence of CRBD at 0 hour (P < 0.01), 1 hour (P < 0.05), 2 hours (P < 0.05) and 6 hours (P < 0.01) postoperatively while dexmedetomidine at 0 hour (P < 0.01) and 2 hours (P < 0.01) after the surgery. Injections paracetamol, amikacin and diphenhydramine were also shown to reduce the incidence of CRBD in separate randomised controlled trials.

Conclusion: The current meta-analysis showed that antimuscarinic agents, tramadol, pregabalin, gabapentin, paracetamol and dexmedetomidine are effective in significantly reducing the incidence of postoperative CRBD.

Keywords: Antimuscarinic agents; catheter; dexmedetomidine; gabapentin; general anaesthesia; paracetamol; pregabalin; systematic review.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram - selection and exclusion of studies from search results. ASA: American Society of Anesthesiologists physical status; VAS: Visual analogue scale; n: Number
Figure 2
Figure 2
Risk of bias summary (a) and graph (b)
Figure 3
Figure 3
Incidence of CRBD in antimuscarinics versus placebo (a) incidence of CRBD at 0 hour, (b)incidence of CRBD at 1 hour, (c) incidence of CRBD at 2 hours, (d) incidence of CRBD at 6 hours). M-H: Mantel–Haenszel; CI: confidence interval; df: degrees of freedom; CRBD: catheter-related bladder discomfort
Figure 4
Figure 4
Incidence of CRBD in tramadol versus placebo (a) incidence of CRBD at 0 hour, (b) incidence of CRBD at 1 hour, (c) incidence of CRBD at 2 hours, (d) incidence of CRBD at 6 hours). M-H: Mantel–Haenszel; CI: confidence interval; df: degrees of freedom; CRBD: catheter-related bladder discomfort
Figure 5
Figure 5
Incidence of CRBD in ketamine versus placebo (a) incidence of CRBD at 0 hour, (b) incidence of CRBD at 1 hour, (c) incidence of CRBD at 2 hours, (d) incidence of CRBD at 6 hours). M-H: Mantel–Haenszel; CI: confidence interval; df: degrees of freedom; CRBD: catheter-related bladder discomfort
Figure 6
Figure 6
Incidence of CRBD in antiepileptics versus placebo (a) incidence of CRBD at 0 hour, (b)incidence of CRBD at 1 hour, (c) incidence of CRBD at 2 hours, (d) incidence of CRBD at 6 hours). M-H: Mantel–Haenszel; CI: confidence interval; df: degrees of freedom; CRBD: catheter-related bladder discomfort
Figure 7
Figure 7
Incidence of CRBD in Dexmedetomidine versus placebo (a) incidence of CRBD at 0 hour, (b) incidence of CRBD at 2 hours. M-H: Mantel–Haenszel; CI: confidence interval; df: degrees of freedom; CRBD: catheter-related bladder discomfort
Figure 8
Figure 8
Funnel plot of comparison to assess publication bias - (a) antimuscarinic agents versus placebo at 6 hours, (b) antiepileptics versus placebo at 6 hours, (c) tramadol versus placebo at 6 hours
See this image and copyright information in PMC

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