Comparison of Tramadol and Dexmedetomidine in the Prevention of Urinary Catheter Discomfort in Urinary Surgery

Study Overview
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Brief Summary
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The investigators aimed to compare the effects of tramadol and dexmedetomidine, which are commonly used in anesthesia, on preventing catheter-related bladder discomfort.

Detailed Description
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Urinary catheterization is an attempt frequently used in many surgeries, emergency services or intensive care units, especially urinary surgeries to facilitate urine output or evaluate urine output. However, as a result of urinary catheter application, most patients may develop some symptoms like pain, burning sensation and the urge to urinate constantly in the suprapubic region that the investigators call this catheter-related bladder discomfort (CRBD). The incidence of CRBD can increase 47 to 90% in the postoperative period. The main reason of CRBD is involuntary contractions caused by muscarinic receptors, especially type 3 (M3) receptors. Therefore, antimuscarinic drugs are used to prevent and treat CRBD. Studies have shown that many drugs such as ketamine, tolterodine, oxybutynin, gabapentin, pregabalin, butylscopolamine, tramadol, dexmedetomidine are effective in preventing CRBD. Their common feature is antimuscarinic effects. However, no definitive conclusion could be reached for routine use, due to the low number of samples in the studies, surgical differences or some anticholinergic and sedative side effects. Additionally, oxybutynin, tolterodine, gabapentin, and pregabalin are only preoperatively administered orally. So more research is needed to find the ideal agent to prevent CRBD. Tramadol is frequently used for moderate pain in surgeries. It is a centrally acting synthetic opioid analgesic that has an inhibitory effect on M1 and M3 muscarinic receptors. Tramadol has proven to be effective in reducing the severity and frequency of ICBR in intraoperative use. However, like other opioids, it can have side effects such as nausea-vomiting and sedation. Dexmedetomidine is a selective alpha-2 adrenoceptor agonist that has analgesic, sympatholytic and sedative properties. In recent studies, it has been reported that dexmedetomidine is associated with the pathophysiology of CRBD by inhibiting type-3 (M3) muscarinic receptor which has beneficial effects in preventing CRBD in intraoperative use. Dexmedetomidine decreases the frequency of CRBD by 30%. The first purpose of the study is to compare the effects of dexmedetomidine and tramadol on CRBD. Secondarily, the investigators aimed to compare them for their side effects.

Official Title
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Comparison of Different Strategies in Preventing Discomfort Due to Urine Catheter in Urinary Surgery

Conditions
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Catheter Related Complication

Intervention / Treatment
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* Drug: Tramadol
* Drug: Dexmedetomidine
* Other: control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients between the ages of 18 and 70 years American Society of Anesthesiologists I or II Scheduled to undergo retrograde intrarenal surgery Scheduled to apply urinary catheter intraoperatively Exclusion Criteria: History of bladder outlet obstruction (Bening prostatic hypertrophy) History of neurogenic bladder History of psychiatric illness Obese patient Patients whose urinary catheter cannot be inserted Patients who had previously urinary catheters

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: tramadol<br>1,5 mg /kg tramadol will perform intraoperatively in 100 ml saline within 15 minutes at 30 minutes before surgery completed. In addition, 1 gr paracetamol will be given intraoperatively. | Drug: Tramadol<br>* tramadol and paracetamol will perform<br>* Other names: Contramal;|
| Active Comparator: dexmedetomidine<br>1 mcg/kg dexmedetomidine bolus will perform after anesthesia induction and followed by infusion of 0.5 mcg/kg/h until 30 minutes before surgery completed. In addition, 1 gr paracetamol will be given intraoperatively. | Drug: Dexmedetomidine<br>* dexmedetomidine and paracetamol will perform<br>* Other names: precedex;|
| Placebo Comparator: control<br>1 gr paracetamol will perform intraoperatively | Other: control<br>* paracetamol will perform<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the severity of CRBD | none - mild- moderate- severe | 0. hour | 
| the severity of CRBD | none - mild- moderate- severe | 1. hour | 
| the severity of CRBD | none - mild- moderate- severe | 3. hour | 
| the severity of CRBD | none - mild- moderate- severe | 6. hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 11-point numerical rating scale (NRS) | 11-point numerical rating scale for pain (0='no pain' and 10='worst pain possible pain') were explained | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dexmedetomidine, tramadol, catheter-related bladder discomfort