Bladder instillation cocktail for preventing catheter-related bladder discomfort after gynecologic surgery: A randomized controlled trial.

Abstract

ObjectiveTo investigate the effectiveness of intravesical instillation of a drug cocktail in preventing postoperative catheter-related bladder discomfort.MethodsIn total, 112 patients were randomized into the "cocktail" or control group. Twenty minutes before the end of the surgery, the "cocktail" group received intravesical instillation of the "cocktail," which contained 1 ug/kg of dexmedetomidine, 5 g of magnesium sulfate, and 10 mg of dexamethasone, totaling 30 mL, while the control group was infused with 30 ml of normal saline. The catheter-related bladder discomfort and visual analog scale of the patients were recorded at 0, 1, 2, and 6 h postoperatively. The 15-item Quality of Recovery scale was used 24 h after surgery to assess the patient's postoperative recovery status.ResultsThe "cocktail" group exhibited significantly decreased catheter-related bladder discomfort severity at 0, 1, 2, and 6 h postoperatively (p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively). For the primary outcome (any catheter-related bladder discomfort at 1 h), the risk ratio was 0.52 (95% confidence interval 0.37 to 0.72). Specifically, compared with the control group, the "cocktail" group exhibited a significant decrease in moderate-to-severe catheter-related bladder discomfort at 0, 1, and 2 h postoperatively (5 (8.9%) vs. 13 (23.2%), p = 0.040; 6 (10.7%) vs. 14 (25.0%), p = 0.048; 4 (7.1%) vs. 12 (21.4%), p = 0.031) with rate ratio 0.33-0.43 (95% confidence interval 0.11 to 0.99). Rescue tramadol dose was significantly lower in the cocktail group (35 ± 8 vs 50 ± 12 mg, p = 0.002; median difference = -15.0 mg, 95% confidence interval -19.2 to -10.8).Moreover, patients in the "cocktail" group exhibited significantly higher postoperative recovery scale scores than those in the control group (median difference = 9.0, 95% confidence interval: 7.0-11.0, p < 0.001).ConclusionBladder instillation of the "cocktail" significantly reduces the severity and incidence of moderate-to-severe catheter-related bladder discomfort and improves postoperative recovery in gynecologic patients.