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- Patrick Tauzin-Fin, Musa Sesay, Laurent Svartz, Marie-Christine Houdeck, Pierre Maurette (18 February 2008)
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Sublingual oxybutynin reduces postoperative pain related to indwelling bladder catheter after radica
- Anil Agarwal, Devendra Gupta (10 January 2008)
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Patrick Tauzin-Fin , Musa Sesay, Laurent Svartz, Marie-Christine Houdeck, Pierre Maurette
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Dear Editor, We hereby reply to the e-letter of Agarwal and colleagues. I is possible that Agarwal and colleagues did not read our paper thoroughly. We also realized that Agarwal and colleagues considered themselves to be the "established norm" for the management of CRBD. Their comments on our paper 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 anaesthtists are routinely confronted with the presence of bladder catheter after major retrotropubic 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. Yours sincerely, Patrick Tauzin-Fin, Musa Sesay, Laurent Svartz, Marie-Christine Houdeck, Pierre Maurette Conflict of Interest:None declared |
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Anil Agarwal, Anaesthesiologist SGPGIMS, Lucknow 226014, India, Devendra Gupta
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We must compliment the Tauzin-Fin et al 1 for recording the severity of CRBD on a numerical scale rather than the subjective analysis of CRBD as has been done by earlier authors 2-5. Like any good study Tauzin-Fin et al article is not without controversy and raises more questions than answer. Tauzin-Fin et al have recorded postoperative discomfort in the supra- pubic region as incisional pain contrary to established norm of treating this symptom as manifestation of catheter related bladder discomfort2-5. It would have been better if authors would have excluded patients undergoing with supra-pubic surgery and thus avoided all the confusion regarding the differentiation of post operative pain and catheter related bladder discomfort. Authors have collectively assessed CRBD and postoperative pain with a single VAS scale but we realize that these are 2 different entities and thus should be assessed on 2 separate scales. Further the observed reduction in the postoperative pain by Tauzin- Fin et al might have been because of the reported anti muscuranic action of tramadol6, which in combination with sublingual oxybutynin must 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. 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. Anesthesia Analgesia 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. Agarwal A, Dhiraaj S, Pawar S, R Kapoor, Gupta D, Singh PK. An evaluation of efficacy of gabapentine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo controlled double blind study. Anaesth Analg 2007; 105: 1454-7. 6. 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. Conflict of Interest:None declared |
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