Prevention of catheter-related bladder discomfort after laparoscopic surgery

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Comparison of intravenous tramadol and ketamine for prevention of catheter-related bladder discomfort after laparoscopic surgery: A randomized, placebo-controlled, double-blind study

Rattanaporn Burimsittichai, M.D.*, Phoonsak Limraksasin, M.D.*, Cameron Paul Hurst, PhD†, Somrat Charuluxananan, M.D., MSc, FRCAT*

• Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University

† Graduate division, Faculty of Medicine, Chulalongkorn University

Background: Catheter-related bladder discomfort (CRBD) is a distressing symptom during recovery from anesthesia. We conducted a randomized controlled trial to assess the efficacy of tramadol and ketamine for prevention of postoperative CRBD after elective laparoscopic surgery.

Objectives: To compare the efficacy of tramadol and ketamine for prevention of CRBD after laparoscopic surgery.

Methods: A total of 210 patients aged 18–70 years and with American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic surgery requiring bladder catheterization were randomly allocated into one of three groups: Group T received intravenous tramadol 1.5 mg/kg, Group K received intravenous ketamine 0.5 mg/kg and Group P received intravenous saline as a placebo before catheterization. Patients received intermittent intravenous morphine for postoperative pain control. An anesthesiologist unaware of the randomization status evaluated CRBD and postoperative pain severity using visual analog scales (VAS). The cumulative pain of CRBD and postoperative pain were calculated by multiplying mean VAS scores by the hours of assessment. Postoperative shoulder pain, 24-hour morphine requirement and adverse effects were also assessed at 0, 1, 2, 6 and 24 hours after surgery.

Results: Groups T and K had significantly less cumulative pain of CRBD compared with placebo (p=0.04 and 0001, respectively). Cumulative postoperative pain, total 24-hour morphine consumption and adverse effects were broadly comparable between the groups. Group T had a significantly lower incidence of shoulder pain (7 out of 67 patients, 10.4%) than Group K (21 out of 70, 30%) and Group P (24 out of 70, 34.3%) 24 hours after surgery (P = 0.006 and 0.001, respectively).

Conclusions: Intravenous tramadol 1.5 mg/kg and ketamine 0.5 mg/kg administered before bladder catheterization are both effective in reducing the 24-hour cumulative postoperative CRBD after elective laparoscopic surgery without significant adverse effects. Tramadol also decreases the incidence of post-laparoscopy shoulder pain.

Keywords: Catheter-related bladder discomfort, ketamine, laparoscopic surgery, laparoscopy, pain, prevention and tramadol