Agarwal A, Yadav G, Gupta D, Singh P K, Singh U
Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
Br J Anaesth. 2008 Oct;101(4):506-10. doi: 10.1093/bja/aen217. Epub 2008 Jul 24.
Catheter-related bladder discomfort (CRBD) is defined as an urge to void or discomfort in the supra-pubic region; reported postoperatively in patients who have had urinary catheterization intra-operatively. We have evaluated tramadol, a centrally acting opioid analgesic with muscarinic receptor antagonist properties for prevention of CRBD.
Fifty-four adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective percutaneous nephro-lithomy were randomly divided into two groups of 27 each. Control (C) group received normal saline (NS; 2 ml), whereas Tramadol (T) group received tramadol 1.5 mg kg(-1). All medications were diluted in 2 ml NS and administered 30 min before extubation. Intra-operatively, urinary catherization was performed with a 16 Fr Foley's catheter, and the balloon was inflated with 10 ml distilled water. The CRBD was assessed at 0, 1, 2, and 6 h after patient's arrival in the post-anaesthesia care unit along with total postoperative fentanyl requirement. Severity of CRBD was graded as none, mild, moderate and severe. Data were analysed by one-way ANOVA, Z-test, and Fisher's exact test. P<0.05 was considered significant.
Incidence and severity of CRBD was reduced in T group compared with C group at all time points (P<0.05). Postoperative pain as assessed by visual analogue scale and total postoperative fentanyl requirement (microg kg(-1)) was also reduced in the T group [176 (SD 26.5)] compared with C group [210 (34.6)] (P<0.05).
Tramadol 1.5 mg kg(-1) administered i.v. 30 min before extubation decreases the incidence and severity of CRBD and postoperative fentanyl requirement.
导尿管相关膀胱不适（CRBD）定义为有排尿冲动或耻骨上区不适；据报道，术中接受导尿的患者术后会出现这种情况。我们评估了曲马多，一种具有毒蕈碱受体拮抗剂特性的中枢性阿片类镇痛药，用于预防CRBD。
54名年龄在18至60岁之间、ASA身体状况为I级和II级的成年男女，接受择期经皮肾镜取石术，随机分为两组，每组27人。对照组（C组）接受生理盐水（NS；2 ml），而曲马多组（T组）接受曲马多1.5 mg·kg⁻¹。所有药物均用2 ml NS稀释，并在拔管前30分钟给药。术中，使用16 Fr Foley导尿管进行导尿，球囊用10 ml蒸馏水充盈。在患者到达麻醉后护理单元后的0、1、2和6小时评估CRBD情况以及术后总的芬太尼需求量。CRBD的严重程度分为无、轻度、中度和重度。数据采用单因素方差分析、Z检验和Fisher精确检验进行分析。P<0.05被认为具有统计学意义。
在所有时间点，T组的CRBD发生率和严重程度均低于C组（P<0.05）。与C组[210（34.6）]相比，T组[176（标准差26.5）]通过视觉模拟量表评估的术后疼痛以及术后总的芬太尼需求量（μg·kg⁻¹）也有所降低（P<0.05）。
拔管前30分钟静脉注射1.5 mg·kg⁻¹曲马多可降低CRBD的发生率和严重程度以及术后芬太尼需求量。
