Postoperative catheter-related pain after radical retropubic prostatectomy
Lucknow, India
* E-mail: aagarwal{at}sgpgi.ac.in
Editor—We compliment Tauzin-Fin and colleagues1 for recording the severity of catheter-related bladder discomfort (CRBD) on a numerical scale rather than the subjective analysis of previous authors.2–4 However, they recorded postoperative discomfort in the supra-pubic region as incisional pain contrary to established norm of treating this symptom as manifestation of CRBD. It would have been better if the authors had excluded patients undergoing supra-pubic surgery and thus avoided the confusion regarding the differentiation of postoperative pain and CRBD. They collectively assessed CRBD and postoperative pain with a single VAS scale, but these are two different entities and thus should be assessed on separate scales.
Further, the observed reduction in the postoperative pain may have been due to the anti-muscuranic action of tramadol,5 which in combination with sublingual oxybutynin may have reduced the incidence and severity of CRBD, thus leading to reduction in supra-pubic discomfort which the authors have observed and reported as reduction in the postoperative pain.
Bordeaux, France
* E-mail: patrick.tauzin-fin{at}chu-bordeaux.fr
Editor—We thank Drs Agarwal and Gupta for their comments, but it is possible that they misunderstood some of our study. Their comments suggest that more efforts are needed to obtain ‘established consensus’ in this field. In our study, we investigated a new and practical approach of postoperative pain. Indeed, anaesthetists are routinely confronted with the presence of a bladder catheter after major retro-pubic surgery. The main question is ‘how do we manage postoperative pain in such a situation’? We demonstrated that postoperative pain was related to both incisional pain and CRBD. These two entities were clearly distinguished in the paper. The patients were able to tell whether the pain was related to the surgical incision or to bladder discomfort (i.e. urge to void). This distinction made it feasible for a specific treatment. In conclusion, we provide a new, simple, and practical approach of postoperative pain management.
References
1 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.
2 Agarwal A, Raza M, Singhal V, et al. Evaluation of efficacy of tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo controlled double blind study. Anesth Analg (2005) 101:1065–7.
3 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.
4 Agarwal A, Gupta D, Kumar M, Dhiraaj S, Tandon M, Singh PK. Ketamine for treatment of catheter related bladder discomfort: a prospective, randomized, placebo controlled and double blind study. Br J Anaesth (2006) 96:587–9.
5 Singh SK, Agarwal MM, Batra YK, Kishore AV, Mandal AK. Effect of lumbar-epidural administration of tramadol on lower urinary tract function. Neurourol Urodyn (2008) 27:65–70.[CrossRef][Web of Science][Medline]
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