- Design
- Prospective randomised double-blind trial
- Population
- 72 adults having TURBT under general anaesthesia
- Primary outcome
- Catheter-related bladder discomfort
- Effect
- Moderate–severe 16.7% vs 58.3% (OR 0.14, 0.05 to 0.43); any 80.6% vs 94.4% (NS)
A double-blind randomised trial in the Journal of International Medical Research, published on 8 October, gave 72 patients having transurethral resection of bladder tumour under general anaesthesia either nefopam 20 mg or saline during surgery.
Any catheter-related bladder discomfort was common in both groups (80.6% vs 94.4%; not significant). Moderate to severe discomfort was much less frequent with nefopam (16.7% vs 58.3%; risk difference −41.7 percentage points, 95% CI −58.6 to −19.5), and quality of recovery at 24 hours was higher.
The trial is small and single-centre, but the effect on the outcome patients notice — moderate to severe urgency and burning — was large.
- Expect catheter-related bladder discomfort in most patients after TURBT; warn them before surgery.
- Consider nefopam, where available, as part of intraoperative analgesia to reduce moderate to severe discomfort.
- Distinguish catheter discomfort from clot retention or blocked catheter before treating it as discomfort.
- Remove the catheter as early as is safe.
Why it matters
Catheter discomfort is one of the most distressing parts of recovery after TURBT, and it is often under-treated.
Don't overread it
A 72-patient single-centre trial; the primary endpoint of any discomfort was not significantly reduced.
The statistics, in plain English
The difference in moderate to severe discomfort has an interval of −58.6 to −19.5 points, so even the smallest plausible effect is substantial. The headline outcome of any discomfort crossed zero and was not significant.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for urology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free