The effect of atropine in preventing catheter-related pain and discomfort in patients undergoing transurethral resection due to bladder tumor; prospective randomized, controlled study

Abstract

Background: Catheter-related bladder discomfort (CRBD) has been observed in many patients undergoing a urethral catheterization. CRBD may be so severe that the patients require additional analgesics. Muscarinic receptors are involved in the mechanism of CRBD. The aim of this study is to determine the effects of the antimuscarinic properties of atropine, which is frequently used in current practice on CRBD, by comparing it with sugammadex which has no antimuscarinic effects. Methods: Sixty patients selected for transurethral resection due to bladder tumors were randomized into 2 groups: an atropine group and a sugammadex group, with no antimuscarinic effect. The patients were given rocuronium (0.6 mg/kg) as a neuromuscular-blocker. In addition to the frequency and severity of CRBD postoperatively at 0, 1, 6, 12, and 24 hours, postoperative numeric rating scale (NRS) scores, and postoperative nausea and vomiting were examined. Results: The incidence of CRBD was significantly lower in the atropine group in all postoperative measurements. The score was found to be significantly lower in the atropine group when NRS measurements were performed at all time periods (P < 0.01). There was no difference between the groups in terms of nausea and vomiting (P > 0.05). Conclusions: Atropine is a cheap, easy-to-access, safe-to-use drug for reducing CRBD symptoms, without any observed adverse effects. Since it not only reduces CRBD symptoms but also has a positive effect on postoperative pain, it can be used safely to increase patient comfort in patients receiving general anesthesia and a urinary catheter.

RE: The effect of atropine in preventing catheter-related pain and discomfort in patients undergoing transurethral resection due to bladder tumor: a prospective, randomized, controlled study

“…Recently, Şahiner et al [1] reported a novel study demonstrating the positive effect of intraoperative atropine in the prevention of postoperative catheter-related bladder discomfort (CRBD) following transurethral resection of bladder tumor (TURBT). The aim of this study was to determine the anticholinergic effect of atropine on suppression of bladder contraction that is known to be related to CRBD.…”

“…Atropine is a cheap and easy-to-use drug with a long history of safe usage. According to Şahiner et al [1], atropine could be an attractive treatment option to treat CRBD without any significant adverse events. The previously used anticholinergics such as butylscopolamine oxybutynin, solifenacin, tolterodine, fesoterodine, imidafenacin, and trospium chloride showed limited effectiveness but caused prominent side effects such as dry mouth and constipation.…”

Author’s reply

“…Currently, the use of atropine as premedication has been abandoned due to its effects on the central nervous system. In our study, atropine was also intraoperatively administered, and no patient received it outside the operating room [ 1 ]. Thus, we did not observe any side effects.…”

“…Thus, we did not observe any side effects. As we stated in the materials and methods section, all participating patients were examined preoperatively, and their clinical cardiac statuses were evaluated, and the patients with previously known or symptomatic heart failure and arrhythmia were excluded [ 1 ].…”

“…As we mentioned in our study, high risk-group medications, such as atropine, must be administered only in risk-free conditions where emergency personnel and equipment i.e. anesthesiologists and anesthetists are available, and patients are monitored in the operating room [ 1 ].…”