The postoperative incidence of catheter-related bladder discomfort (CRBD) ranges from 47% to 95%. It increases postoperative pain and agitation, thus requiring early intervention. Although a variety of drugs are used for the prevention or treatment of CRBD, the adverse reactions of most of these drugs have limited their clinical application. In long-term clinical practice, we found that indomethacin suppository has a good therapeutic effect on the discomfort of pelvic-related organs caused by nociceptive stimulation. However, its preventive effect on CRBD has not been reported yet. We hypothesized that indomethacin suppository has a preventive effect on postoperative CRBD. To verify this hypothesis, patients undergoing laparoscopic radical prostatectomy were enrolled in the study. Patients in the intervention group received 50 mg of indomethacin suppository via the rectal route immediately after surgery, while those in the control group received no treatment. The severity of CRBD, pain scores, consumption of analgesics, other perioperative adverse reactions, and patient satisfaction were observed and recorded at 0, 1, 2, and 6 hours after surgery.
Aged 18 to 80 years old (inclusive);
American Society of Anesthesiologists (ASA) physical status classification Class I-III;
Undergoing elective laparoscopic radical prostatectomy under general anesthesia;
Having a clear understanding of the study, voluntarily participating, and providing informed consent signed by themselves or their family members.
Pre-existing bladder diseases, such as overactive bladder (frequency of micturition > 3 times per night or > 8 times within 24 hours), neurogenic bladder, and bladder outlet obstruction;
Postoperative status of pelvic organs or spine that affects bladder function;
Postoperative status of total proctocolectomy;
Severe cardiac insufficiency (activity tolerance < 4 METs) or clearly diagnosed coronary heart disease;
Parallel
Indomethacin suppository
Other interventionAll patients received preoperative education on distinguishing catheter-related bladder discomfort (CRBD) from surgical somatic pain. Anesthesia was induced with sufentanil 3μg/kg, propofol 2mg/kg and rocuronium 0.6mg/kg. Anesthesia was maintained with combined propofol, remifentanil and sevoflurane. Fifteen minutes before surgery completion, intravenous ondansetron 4 mg was given for postoperative nausea and vomiting prophylaxis, and sufentanil 1 μg/kg was administered for postoperative analgesia. Drugs potentially interfering with study outcomes including dexmedetomidine, dezocine, tramadol and other non-steroidal anti-inflammatory drugs were prohibited. At the end of surgery when removing sterile drapes, interventions were performed as follows: Rectal administration of 50 mg indomethacin suppository.
The incidence of moderate to severe CRBD within 0-1 hour after surgery
Catheter-related bladder discomfort will be assessed immediately after extubation. The severity of catheter-related bladder discomfort was graded as follows: 0 score: no discomfort; 1. score (mild): discomfort reported only on questioning; 2. score (moderate): discomfort reported spontaneously without behavioral response; 3. score (severe): discomfort reported spontaneously with behavioral responses (e.g., flailing limbs, vocalization, or attempting to remove the catheter). The incidence of moderate and severe CRBD within 0-1 hour postoperatively will be recorded.
The incidence of moderate to severe CRBD at 1, 2, and 6 hours postoperatively
Catheter-related bladder discomfort will be assessed. The severity of catheter-related bladder discomfort was graded as follows: 0 score: no discomfort; 1. score (mild): discomfort reported only on questioning; 2. score (moderate): discomfort reported spontaneously without behavioral response; 3. score (severe): discomfort reported spontaneously with behavioral responses (e.g., flailing limbs, vocalization, or attempting to remove the catheter). The incidence of moderate and severe CRBD at 1, 2, and 6 hours postoperatively will be recorded.
CRBD severity score at 0, 1, 2, and 6 hours postoperatively
Catheter-related bladder discomfort will be assessed. The severity of catheter-related bladder discomfort was graded as follows: 0 score: no discomfort; 1. score (mild): discomfort reported only on questioning; 2. score (moderate): discomfort reported spontaneously without behavioral response; 3. score (severe): discomfort reported spontaneously with behavioral responses (e.g., flailing limbs, vocalization, or attempting to remove the catheter). CRBD severity at 0, 1, 2, and 6 hours postoperatively will be recorded.
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