The purpose of this study was to compare the efficacy of tolterodine and gabapentin versus placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL).
This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg PO (group T, N=50), gabapentin 600 mg PO (group G, N=50), and placebo (group P, N=70) one hour before operation using balanced block randomization. The primary endpoint of interest was visual analogue pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and non-opioid).
The frequency of severe CRBD in 1,12, and 24 hours after the operation were 4%, 4% and 6% in group T versus 4%, 0% and 2% in group G versus 47%, 14% and 6% in the P group (p<0.001). The number of paracetamol injections for CRBD in the T and G groups were significantly lower than the placebo group (1.8±0.8 versus 1.8±0.7 versus 3.6±0.7, p<0.001). Likewise the number of pethidine injections in the T and G groups were significantly lower than the placebo group (0.42±0.54 versus 0.68±0.62 versus 2.4±0.64, p<0.001). In patients with history of Dj insertion, the severity of CRBD was lower in all treatment groups.
Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics up to 24 hours after surgery. Patients with history of Dj insertion experience less CRBD.
Journal of endourology. 2017 Dec 26 [Epub ahead of print]
Robab- Maghsoudi, Saeed Farhadi-Niaki, Masoud Etemadian, Amir Hossein Kashi, Pejman Shadpour, Asemaneh Shirani, Rana Samadinezhad-Khoshbaf-Sorkhabi, Meghdad Tabatabaei
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