Li Shuying, Li Ping, Wang Rurong, Li Hui
Department of Anesthesiology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Deficits and Related Diseases of Women and Children, Sichuan University, Ministry of education, Renmin Nanlu, Chengdu, China.
Department of Anesthesiology,West China Hospital, Sichuan University, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Guoxue Alley, No 37, Chengdu, China.
Eur J Clin Pharmacol. 2022 Jun;78(6):897-906. doi: 10.1007/s00228-021-03251-5. Epub 2022 Feb 26.
Catheter-related bladder discomfort (CRBD) is a common complication of intraoperative urinary catheterization. Various studies have evaluated the efficacy of different interventions in postoperative CRBD. The present review was performed to assess the efficacy of these interventions.
PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were systematically searched to identify randomized controlled trials (RCTs) investigating the efficacy of different drugs for the prevention of postoperative CRBD. This review evaluated the incidence and severity of CRBD after different interventions at 0, 1, 2, and 6 h postoperatively.
Forty-five studies including 31 different drugs were analyzed. Eleven drugs were investigated in more than two RCTs, of which dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and pudendal nerve block (PNB) generally showed significantly higher efficacy than controls postoperatively. Solifenacin only showed significant efficacy compared with the control at 0 h, and intravenous lidocaine only showed significant efficacy compared with the control at 6 h. There were insufficient trials to draw conclusions regarding atropine, butylscopolamine, chlorpheniramine, clonidine, darifenacin, diphenhydramine, glycopyrrolate, intravesical bupivacaine, ketamine-haloperidol, pethidine-haloperidol, ketorolac, lidocaine-prilocaine cream, magnesium, hyoscine n-butyl bromide, oxycodone, paracetamol, parecoxib, trospium, resiniferatoxin, or amikacin. However, all but pethidine-haloperidol and chlorpheniramine showed some efficacy at various time points compared with controls.
This review suggests that dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and PNB are effective in preventing postoperative CRBD. Considering the efficacy and adverse effects of all drugs, dexmedetomidine and gabapentin were ranked best.
导尿管相关膀胱不适（CRBD）是术中留置尿管常见的并发症。多项研究评估了不同干预措施对术后CRBD的疗效。本综述旨在评估这些干预措施的疗效。
系统检索PubMed、Embase和CENTRAL（Cochrane对照试验中央注册库）数据库，以识别调查不同药物预防术后CRBD疗效的随机对照试验（RCT）。本综述评估了术后0、1、2和6小时不同干预措施后CRBD的发生率和严重程度。
分析了45项研究，包括31种不同药物。超过两项RCT对11种药物进行了研究，其中右美托咪定、加巴喷丁、托特罗定、曲马多、氯胺酮、奈福泮、奥昔布宁、普瑞巴林和阴部神经阻滞（PNB）术后疗效通常显著高于对照组。索利那新仅在0小时与对照组相比显示出显著疗效，静脉注射利多卡因仅在6小时与对照组相比显示出显著疗效。关于阿托品、丁溴东莨菪碱、氯苯那敏、可乐定、达非那新、苯海拉明、格隆溴铵、膀胱内布比卡因、氯胺酮-氟哌啶醇、哌替啶-氟哌啶醇、酮咯酸、利多卡因-丙胺卡因乳膏、镁、丁溴东莨菪碱、羟考酮、对乙酰氨基酚、帕瑞昔布、曲司氯铵、树脂毒素或阿米卡星，由于试验不足，无法得出结论。然而，除哌替啶-氟哌啶醇和氯苯那敏外，所有药物在不同时间点与对照组相比均显示出一定疗效。
本综述表明，右美托咪定、加巴喷丁、托特罗定、曲马多、氯胺酮、奈福泮、奥昔布宁、普瑞巴林和PNB可有效预防术后CRBD。综合所有药物的疗效和不良反应，右美托咪定和加巴喷丁排名最佳。
