Preoperative Oral Gabapentin in the Management of Postoperative Catheter-Related Bladder Discomfort in Adults: A Systematic Review and Meta-Analysis

Abstract

Objective: To evaluate the efficacy and safety of preoperative oral gabapentin in preventing postoperative Catheter-Related Bladder Discomfort (CRBD) in surgical patients.Methods: Randomized controlled trials in which gabapentin was used for the prevention of CRBD in surgical patients with transurethral catheterization were evaluated. The primary outcome was the incidence of moderate-to-severe CRBD at 0, 1, 2, and 6 h after surgery, and secondary outcomes included the incidence of any grade CRBD, postoperative pain, and adverse events. Pooled risk ratios (RRs) and mean difference (MD), 95% confidence intervals (CIs), and P values were estimated using fixed and random effects statistical models. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the levels of certainty for key results.Results: A total of 6 randomized controlled trials involving 679 participants were included in the meta-analysis. Gabapentin significantly reduced the risk of moderate-to-severe CRBD at 0, 1, 2, and 6 h (0 h: RR = 0.19, 95% CI: 0.11 to 0.31, p < 0.00001; 1 h: RR = 0.40, 95% CI: 0.25 to 0.66, p < 0.001; 2 h: RR = 0.38, 95% CI: 0.26 to 0.56, p < 0.00001; 6 h: RR = 0.20, 95% CI: 0.11 to 0.38, p < 0.00001). The overall incidence of CRBD at 1 h showed no statistical difference between the two groups (RR = 0.55, 95% CI: 0.30 to 1.00, p = 0.05). The risk of CRBD was significantly reduced in the gabapentin group at 0, 2, and 6 h after surgery (0 h: RR = 0.59, 95% CI: 0.46 to 0.74, p < 0.0001; 2 h: RR = 0.62, 95% CI: 0.51 to 0.75, p < 0.00001; 6 h: RR = 0.66, 95% CI: 0.52 to 0.83, p < 0.001). In addition, gabapentin was associated with low postoperative pain intensity without significant side effects.Conclusion: Preoperative oral gabapentin as an adjunct to surgery is effective in decreasing the risk and severity of CRBD over a short time after surgery, and it can decrease postoperative pain without significant side effects. Overall, the level of certainty was moderate to low.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42021228171.

Gabapentin and Rapidity of Recovery Among Patients Undergoing Minimally Invasive Ambulatory Uro-Oncologic Surgeries

“…For example, there is some evidence that gabapentin may be useful in decreasing the incidence and severity of catheter-related bladder discomfort. [17][18][19] Clarifying the role of gabapentin within a multimodal pain approach and determining its ability to reduce opioid consumption, alleviate pain, and shorten hospital stays are necessary to improve patient outcomes and enhance quality of life for individuals undergoing urologic oncological procedures.…”

Effect of magnesium sulfate perioperative infusion on postoperative catheter-related bladder discomfort in male patients undergoing laparoscopic radical resection of gastrointestinal cancer: a prospective, randomized and controlled study

“…The severity of CRBD was recorded as follows: None, patients complained of no bladder discomfort when asked; Mild, patients complained of slight urethral discomfort only when they were asked; Moderate, patients actively expressed urethral discomfort when they were not asked but were able to comply with movements without abnormal physical behavior; Severe, patients were not asked, and they actively expressed urinary urge, urethral burning, or foreign body sensation accompanied by behavioral reactions such as emotional irritability and limb movement [ 6 ].CRBD often occurs in the early postoperative period, especially in the post-anesthesia care unit (PACU) [ 6 ]. Some drugs, such as gabapentin, ketamine, and tramadol, have shown varying degrees of success in the prevention of CRBD, however, the incidence of CRBD still reaches 47–90% [ 7 – 10 ]. It is a painful complication, but it is often neglected in the clinic.…”