Effect of nefopam on postoperative catheter-related bladder discomfort after transurethral resection of the bladder under general anesthesia: A randomized controlled trial

Objective Catheter-related bladder discomfort is a common complication following transurethral resection of bladder tumor and may impair postoperative recovery. This study evaluated the effect of intraoperative nefopam on catheter-related bladder discomfort and postoperative recovery quality. Methods In this prospective, randomized, double-blind trial, patients undergoing transurethral resection of bladder tumor under general anesthesia were allocated to either Group N (nefopam, 20 mg) or Group S (normal saline). Catheter-related bladder discomfort was assessed using a 4-point scale at multiple postoperative time points. Catheter-related bladder discomfort was defined based on a score ≥1, and moderate-to-severe catheter-related bladder discomfort was defined based on a score ≥2. Postoperative recovery quality was evaluated using the Quality of Recovery 15 questionnaire. Results In total, 72 patients were analyzed. The cumulative incidence of catheter-related bladder discomfort (score ≥1) was 80.6% in Group N and 94.4% in Group S (risk difference, −13.9%; 95% confidence interval, −30.0% to 2.0%; p = 0.076). Longitudinal analysis of catheter-related bladder discomfort severity revealed significant time and group × time interaction effects (both p < 0.001), with lower odds of greater catheter-related bladder discomfort severity in Group N during the early postoperative period. Moderate-to-severe catheter-related bladder discomfort (score ≥2) occurred in 16.7% of the patients in Group N and 58.3% of those in Group S (risk difference, −41.7%; 95% confidence interval, −58.6% to −19.5%; odds ratio, 0.14; 95% confidence interval, 0.05–0.43; p < 0.001). The Quality of Recovery 15 score at 24 h was higher in Group N than in Group S (133.5 ± 11.25 vs. 124.3 ± 14.1; mean difference, 9.2 points; 95% confidence interval, 3.2–15.2; p = 0.003). Conclusions Intraoperative nefopam did not significantly reduce the cumulative incidence of catheter-related bladder discomfort; however, it was associated with lower early postoperative catheter-related bladder discomfort severity and a lower incidence of moderate-to-severe catheter-related bladder discomfort. Quality of Recovery 15 scores at 24 h were also higher in the nefopam group. Registration: This study was registered with the Clinical Research Information Service (https://cris.nih.go.kr/, KCT0011457)