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Prevention of catheter-related bladder discomfort after laparoscopic surgery

Catheter-related bladder discomfort (CRBD) is a distressing complication after surgery defined as a burning sensation with an urge to void or discomfort in the suprapubic region. The mechanism involves involuntary contraction of detrusor muscles. Several medications have been used for prevention and treatment of the symptoms. Tramadol and ketamine are commonly administered intravenously during anesthesia and they carry an anti-muscarinic property, that inhibits bladder contraction and helps reduce proportion of patients reporting CRBD.

Laparoscopic surgery is a minimally invasive surgery promoting smaller incisions, less postoperative pain and faster recovery. However, patients requiring urinary catheterization often complain of bladder pain which is worse than the surgical pain.

Nowadays, the standard management for CRBD has not established yet, therefore, tramadol and ketamine were compared for prevention of CRBD after elective laparoscopic surgery. The randomized, placebo-controlled, double-blind study of 210 adult patients who underwent elective laparoscopic surgery at King Chulalongkorn Memorial Hospital demonstrated that intravenous tramadol 1.5 mg/kg and ketamine 0.5 mg/kg administered before bladder catheterization are effective in reducing the 24-h cumulative postoperative CRBD after elective laparoscopic surgery without significant differences in cumulative postoperative pain, total 24-h morphine consumption and adverse effects such as sedation, postoperative nausea and vomiting, respiratory depression, hallucination and blurred vision compared with placebo. Tramadol also reduced the incidence of post-laparoscopy shoulder pain.