Skip to main content

Effect of chlorpheniramine administration on postoperative catheter-related bladder discomfort in patients undergoing transurethral excision of bladder tumor: a prospective randomized study

Abstract

Purpose

Catheter-related bladder discomfort (CRBD) is postoperative distress caused by a urinary catheter. CRBD is related to muscarinic receptor activation. Chlorpheniramine has antimuscarinic properties. Hence, this investigation was undertaken to evaluate the efficacy of chlorpheniramine in preventing CRBD in patients undergoing transurethral resection of bladder tumor (TURBT).

Methods

Seventy-six patients scheduled for TURBT under general anesthesia were assigned into two groups. In the chlorpheniramine group (n = 38), 100 ml normal saline containing 0.1 mg/kg chlorpheniramine was infused after general anesthesia induction. In the control group (n = 38), 100 ml normal saline alone was infused. The incidence and severity of CRBD were assessed at 1, 6, and 24 h postoperatively.

Results

The 1-h postoperative incidence of CRBD was lower in the chlorpheniramine group based on the unadjusted analysis [16 (42%) vs. 28 (74%), risk difference 32%, 95% confidence interval 8–51, p = 0.005]. After adjusting the size of the urinary catheter, post hoc analysis showed that the 1-h postoperative incidence of CRBD was lower in the chlorpheniramine group (p = 0.004). The CRBD severity score was lower in the chlorpheniramine group at 1 and 6 h after operation based on the unadjusted analysis (p = 0.012 and p = 0.007, respectively). After adjusting the urinary catheter size, post hoc analysis showed that 1- and 6-h CRBD severity score was lower in the chlorpheniramine group (p = 0.012 and p = 0.008, respectively). The incidence of rescue medication was lower in the chlorpheniramine group [10 (26%) vs. 20 (53%), risk difference 26%, 95% confidence interval 3–47, p = 0.019]. The overall incidence of complications such as nausea, vomiting, dry mouth, flushing, dizziness, and blurred vision was comparable between the two groups.

Conclusions

Chlorpheniramine administration significantly reduces the incidence and severity of CRBD in the patients undergoing TURBT.

Trial registration

KCT0004880 (https://cris.nih.go.kr/)

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Agarwal A, Dhiraaj S, Singhal V, Kapoor R, Tandon M. Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth. 2006;96:377–80.

    CAS  Article  Google Scholar 

  2. 2.

    Tauzin-Fin P, Sesay M, Svartz L, Krol-Houdek MC, Maurette P. Sublingual oxybutynin reduces postoperative pain related to indwelling bladder catheter after radical retropubic prostatectomy. Br J Anaesth. 2007;99:572–5.

    CAS  Article  Google Scholar 

  3. 3.

    Agarwal A, Yadav G, Gupta D, Singh PK, Singh U. Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study. Br J Anaesth. 2008;101:506–10.

    CAS  Article  Google Scholar 

  4. 4.

    Kim HC, Lee YH, Jeon YT, Hwang JW, Lim YJ, Park JE, Park HP. The effect of intraoperative dexmedetomidine on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumour resection: a double-blind randomised study. Eur J Anaesthesiol. 2015;32:596–601.

    CAS  Article  Google Scholar 

  5. 5.

    Kim HC, Lim SM, Seo H, Park HP. Effect of glycopyrrolate versus atropine coadministered with neostigmine for reversal of rocuronium on postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor: a prospective randomized study. J Anesth. 2015;29:831–5.

    Article  Google Scholar 

  6. 6.

    Binhas M, Motamed C, Hawajri N, Yiou R, Marty J. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim. 2011;30:122–5.

    CAS  Article  Google Scholar 

  7. 7.

    Johansson SL, Cohen SM. Epidemiology and etiology of bladder cancer. Semin Surg Oncol. 1997;13:291–8.

    CAS  Article  Google Scholar 

  8. 8.

    Rodriguez Faba O, Gaya JM, López JM, Capell M, De Gracia-Nieto AE, Gómez Correa E, Breda A, Palou J. Current management of non-muscle-invasive bladder cancer. Minerva Med. 2013;104:273–86.

    CAS  PubMed  Google Scholar 

  9. 9.

    Rumore MM. Clinical pharmacokinetics of chlorpheniramine. Drug Intell Clin Pharm. 1984;18:701–7.

    CAS  Article  Google Scholar 

  10. 10.

    Yasuda SU, Yasuda RP. Affinities of brompheniramine, chlorpheniramine, and terfenadine at the five human muscarinic cholinergic receptor subtypes. Pharmacotherapy. 1999;19:447–51.

    CAS  Article  Google Scholar 

  11. 11.

    Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656–9.

    CAS  Article  Google Scholar 

  12. 12.

    Yu D, Chai W, Sun X, Yao L. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth. 2010;57:843–8.

    Article  Google Scholar 

  13. 13.

    Kimura K, Adachi M, Kubo K. H1- and H2-receptor antagonists prevent histamine release in allergic patients after the administration of midazolam-ketamine. A randomized controlled study. Inflamm Res. 1999;48:128–32.

    CAS  Article  Google Scholar 

  14. 14.

    Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002;3:159–80.

    Article  Google Scholar 

  15. 15.

    Ryu JH, Hwang JW, Lee JW, Seo JH, Park HP, Oh AY, Jeon YT, Do SH. Efficacy of butylscopolamine for the treatment of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth. 2013;111:932–7.

    CAS  Article  Google Scholar 

  16. 16.

    Yamanishi T, Chapple CR, Chess-Williams R. Which muscarinic receptor is important in the bladder? World J Urol. 2001;19:299–306.

    CAS  Article  Google Scholar 

  17. 17.

    Pagoria D, O’Connor RC, Guralnick ML. Antimuscarinic drugs: review of the cognitive impact when used to treat overactive bladder in elderly patients. Curr Urol Rep. 2011;12:351–7.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2018R1C1B6007539).

Author information

Affiliations

Authors

Contributions

Conceptualization: HCK, HH, SWL. Data curation: HH, JEC. Formal analysis: HCK, HH, SWL, JEC. Funding acquisition: HH. Investigation: JEC, SWL. Methodology: HCK, HH, SWL, JEC. Resources: JEC, SWL. Software: HH, HCK. Supervision: HCK. Validation: HH, SWL, JEC. Visualization: HCK. Writing—original draft: HCK, HH. Writing—review and editing: HH, SWL, JEC.

Corresponding author

Correspondence to Hyun-Chang Kim.

Ethics declarations

Conflict of interest

No competing interests declared.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 223 KB)

About this article

Verify currency and authenticity via CrossMark

Cite this article

Huh, H., Lee, S.W., Cho, J.E. et al. Effect of chlorpheniramine administration on postoperative catheter-related bladder discomfort in patients undergoing transurethral excision of bladder tumor: a prospective randomized study. J Anesth 35, 646–653 (2021). https://doi.org/10.1007/s00540-021-02970-4

Download citation

Keywords

  • Urinary catheter
  • Chlorpheniramine
  • Urinary bladder neoplasm