Paracetamol for Catheter Related Bladder Discomfort

Overview

The insertion of an urinary catheter in a patient undergoing a surgical procedure, especially in urinary interventions, may lead to catheter-related bladder discomfort with varying degrees of severity during the postoperative period. Catheter-related bladder discomfort (CRBD) symptoms associated with indwelling urinary catheter are similar to overactive bladder symptoms such as discomfort in the suprapubic region, urinary urgency, frequency, burning sensation with or without urge incontinence. Paracetamol is a drug with proven efficiency for the management of mild and moderate postoperative pain. In this study, the investigators hypothesized to address the effect of single-dose intravenous paracetamol on postoperative CRBD following percutaneous nephrolithotomy surgery (PNL).

Full Title of Study: “THE EFFECT OF INTRAOPERATIVE PARACETAMOL ON CATHETER-RELATED BLADDER DISCOMFORT: A PROSPECTIVE, RANDOMISED, DOUBLE-BLIND STUDY”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: July 2009

Interventions

  • Drug: intravenous paracetamol
  • Drug: Placebo

Arms, Groups and Cohorts

  • Placebo Comparator: Group Control (n=32):iv 1.5 ml/kg 0.9% NaCl
  • Active Comparator: Group Paracetamol(n=32):iv 15mg/kg paracetamol
    • The patients were randomly divided into two groups: Group P (Paracetamol group, n=32) received intravenous 15mg/kg paracetamol during the surgery and Group C (Control Group, n=32) received intravenous 1.5 ml/kg 0.9% NaCl solution 30 minutes before the of surgery.At the end of the surgery, all patients had an nephrostomy catheter and the insertion site was infiltrated with 20 ml 0.25% bupivacaine infiltration for postoperative analgesia. Each patient received patient-controlled intravenous analgesia by meperidine (10 mg bolus, 20-minute lock-out, no infusion dose and 4 hour limit) for postoperative analgesia. All patients were planned to receive tenoxicam 20 mg intravenously as a rescue analgesic when visual analogue scale (VAS) was >3.

Clinical Trial Outcome Measures

Primary Measures

  • Reducing of Catheter related bladder discomfort symptoms
    • Time Frame: CRBD was evaluated at postoperatively 30th minutes, 1st, 2nd, 4th, 6th and 12th hours
    • CRBD was evaluated with a 4 point scale (1; no discomfort, 2; mild, revealed on questioning only, 3; moderate, stated by the patient without questioning, 4; severe, urinary urgency executed by behavioral responses, such as attempts to remove urinary catheter, restless extremity movements, verbal responses) at postoperatively 30th minutes, 1st, 2nd, 4th, 6th and 12th hours.

Secondary Measures

  • Assessment of CRBD symptoms by the evaluation of VAS, sedation scales and hemodynamic findings
    • Time Frame: at postoperatively 30th minutes, 1st, 2nd, 4th, 6th and 12th hours.

Participating in This Clinical Trial

Inclusion Criteria

  • ≥ 18 years of age,
  • American Society of Anesthesiologists (ASA) Physical Status of I-II,
  • undergoing PNL with urinary bladder catheter.

Exclusion Criteria

  • obesity (BMI > 30),
  • chronic opioid use,
  • bladder outflow obstruction,
  • benign prostatic hyperplasia, and
  • overactive bladder (OAB) (frequency > 3 times at night or > 8 times within 24h).

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 65 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Pinar Ergenoglu
  • Provider of Information About this Clinical Study
    • Sponsor-Investigator: Pinar Ergenoglu, Baskent University School of Medicine Adana Teaching and Research Hospital – Baskent University

References

Agarwal A, Yadav G, Gupta D, Singh PK, Singh U. Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study. Br J Anaesth. 2008 Oct;101(4):506-10. doi: 10.1093/bja/aen217. Epub 2008 Jul 24.

Binhas M, Motamed C, Hawajri N, Yiou R, Marty J. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim. 2011 Feb;30(2):122-5. doi: 10.1016/j.annfar.2010.12.009. Epub 2011 Jan 31.

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