Objective  To investigate the effect of intravenous flurbiprofen axetil on the incidence and severity of catheter-related bladder discomfort (CRBD) after transurethral resection of the prostate (TURP).

Methods The elderly patients undergoing TURP under general anesthesia were enrolled, and randomly divided into two groups: flurbiprofen axetil group (group F) and control group (group C). Ten minutes before the end of surgery, group F was given 50 mg of flurbiprofen axetil intravenously, group C was given an equal amount of 0.9% sodium chloride injection. The primary outcome indicator was the incidence of moderate to severe CRBD immediately after entering the resuscitation room (T0). Secondary indicators included the incidence and severity of CRBD at 1 h (T1), 2 h (T2), and 6 h (T3) after entering the resuscitation room, the amount of sufentanil used within 24 hours after surgery, postoperative NRS score, flurbiprofen axetil-related and analgesic adverse reactions 24 hours after surgery, and patient satisfaction.

Results  A total of 90 patients were included and each group was 45 patients. The incidence of moderate to severe CRBD at T0 was significantly lower in group F than that in group C (8.9% vs. 33.3%, P=0.004). The incidence of CRBD in T1, T2, and T3 was lower in group F than in group C (P<0.05). The incidence of mild CRBD at T3 in group F was lower than that in group C (P<0.05). The incidence of moderate to severe CRBD at T1 and T2 in groups F was lower than that in group C (P<0.05). The amount of sufentanil used in group F at 24 hours after surgery was significantly lower than that in group C (P=0.001). The pain scores in group F at T0, T1, T2, and T3 were lower than those in group C (P<0.05); The postoperative patient satisfaction score in group F was higher than that in group C (P=0.001). However, there were no significant differences between the two groups in postoperative anesthesia resuscitation time and 24-hour adverse reactions incidence (P>0.05).

Conclusion  Intravenous flurbiprofen axetil can safely and effectively reduce the incidence and severity of CRBD after TURP. It can significantly relieve pain, reduce sufentanil use, and have high clinical application value.

1.Park JY, Baek JW, Yu J, et al. Vitamin C and catheter-related bladder discomfort after transurethral resection of bladder tumor: a double-blind, randomized, placebo-controlled study[J]. J Clin Anesth, 2023, 89: 111191. DOI: 10.1016/j.jclinane.2023.111191.

2.Jang EB, Hong SH, Kim KS, et al. Catheter-related bladder discomfort: how can we manage it?[J]. Int Neurourol J, 2020, 24(4): 324-331. DOI: 10.5213/inj.2040108.054.

3.Bai Y, Wang X, Li X, et al. Management of catheter-related bladder discomfort in patients who underwent elective surgery[J]. J Endourol, 2015, 29(6): 640-649. DOI: 10.1089/end.2014.0670.

4.Park JY, Yu J, Kim CS, et al. Transcutaneous electrical nerve stimulation and catheter-related bladder discomfort following transurethral resection of bladder tumour: a randomised controlled trial[J]. Eur J Anaesthesiol, 2024, 41(11): 821-830. DOI: 10.1097/EJA.0000000000002050.

5.Huang L, Zheng X, Zhang Y, et al. Flurbiprofen axetil alleviates the effect of formalin-induced inflammatory pain on the cognitive function of rats with mild cognitive impairment through the AMPKα/NF-κB signaling pathway[J]. Ann Transl Med, 2022, 10(22): 1210. DOI: 10.21037/atm-22-4997.

6.谢烨琳, 王结兰. 氟比洛芬酯注射液致眩晕、胸闷、呼吸困难1例[J]. 药物流行病学杂志, 2020, 29(3): 214-215. DOI: 10.19960/j.cnki.issn1005-0698.2020.03.015.

7.Wang RD, Sheng XR, Guan WX, et al. Flurbiprofen axetil for postoperative analgesia in upper abdominal surgery: a randomized, parallel controlled, double-blind, multicenter clinical study[J]. Surg Today, 2020, 50(7): 749-756. DOI: 10.1007/s00595-019-01951-1.

8.丁雪飞, 栾阳, 卢圣铭, 等. 联合应用前列腺周围神经阻滞麻醉和氟比洛芬酯的多模式镇痛在前列腺穿刺活检中的应用效果[J]. 中华外科杂志, 2019, 57(6): 428-433. [Ding XF, Luan Y, Lu SM, et al. Effect of multimodal analgesia using periprostatic nerve block anesthesia combined with flurbiprofen in transperineal template-guided prostate biopsy[J]. Chinese Journal of Surgery, 2019, 57(6): 428-433.] DOI: 10.3760/cma.j.issn.0529-5815.2019.06.007.

9.Bach H, Kaasby K, Sørensen A, et al. Incidence and severity of catheter-related bladder discomfort among nonurological adult patients in a postanesthesia care unit[J]. J Perianesth Nurs, 2020, 35(1): 29-33. DOI: 10.1016/j.jopan.2019.06.013.

10.Lin CH, Lu IC, Gau TP, et al. Preventing postoperative catheter-related bladder discomfort (CRBD) with bladder irrigation using 0.05% lidocaine saline solution: monitoring with analgesia nociception index (ANI) after transurethral surgery[J]. Medicina (Kaunas), 2024, 60(9): 1405. DOI: 10.3390/medicina60091405.

11.Jiang W, Zeng X, Zhou X, et al. Effect of magnesium sulfate perioperative infusion on postoperative catheter-related bladder discomfort in male patients undergoing laparoscopic radical resection of gastrointestinal cancer: a prospective, randomized and controlled study[J]. BMC Anesthesiol, 2023, 23(1): 396. DOI: 10.1186/s12871-023-02346-z.

12.Li XQ, Zhang XR, Liu J, et al. Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries: a randomized, controlled, double-blind trial[J]. Medicine (Baltimore), 2017, 96(49): e8932. DOI: 10.1097/MD.0000000000008932.

13.王沛, 仓静. 全麻术后导尿管相关膀胱不适的研究进展 [J].临床麻醉学杂志, 2020, 36(9): 932-934. DOI: 10.12089/jca.2020.09.022.

14.Mitobe Y, Yoshioka T, Baba Y, et al. Predictors of catheter-related bladder discomfort after surgery: a literature review[J]. J Clin Med Res, 2023, 15(4): 208-215. DOI: 10.14740/jocmr4873.

15.Göger YE, Özkent MS, Göger E, et al. A randomised-controlled, prospective study on the effect of dorsal penile nerve block after TURP on catheter-related bladder discomfort and pain[J]. Int J Clin Pract, 2021, 75(5): e13963. DOI: 10.1111/ijcp.13963.

16.Zhang T, Li H, Lin C, et al. Effects of an intraoperative intravenous bolus dose of dexmedetomidine on postoperative catheter-related bladder discomfort in male patients undergoing transurethral resection of bladder tumors: a randomized, double-blind, controlled trial[J]. Eur J Clin Pharmacol, 2024, 80(3): 465-474. DOI: 10.1007/s00228-024-03625-5.

17.Tijani KH, Akanmu NO, Olatosi JO, et al. Role of tolterodine in the management of postoperative catheter-related bladder discomfort: findings in a Nigerian teaching hospital[J]. Niger J Clin Pract, 2017, 20(4): 484-488. DOI: 10.4103/1119-3077.196036.

18.Maghsoudi R, Farhadi-Niaki S, Etemadian M, et al. Comparing the efficacy of tolterodine and gabapentin versus placebo in catheter related bladder discomfort after percutaneous nephrolithotomy: a randomized clinical trial[J]. J Endourol, 2018, 32(2): 168-174. DOI: 10.1089/end.2017.0563.

19.Wu X, Luo H, Bao Q, et al. Effects of butorphanol combined with dexmethoprim on inflammatory response and prognosis of postoperative analgesia after transurethral resection of prostate[J]. Minerva Surg, 2022, 77(5): 518-520. DOI: 10.23736/S2724-5691.21.09334-5.

20.Kim DH, Park JY, Yu J, et al. Intravenous lidocaine for the prevention of postoperative catheter-related bladder discomfort in male patients undergoing transurethral resection of bladder tumors: a randomized, double-blind, controlled trial[J]. Anesth Analg, 2020, 131(1): 220-227. DOI: 10.1213/ANE.0000000000004405.

21.Jendoubi A, Aissi W, Abbes A, et al. Efficacy and safety of parecoxib for prevention of catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor: prospective randomised trial[J]. Indian J Anaesth, 2018, 62(6): 461-465. DOI: 10.4103/ija.IJA_137_18.

22.Ogata K, Takamura N, Tokunaga J, et al. A novel injection strategy of flurbiprofen axetil by inhibiting protein binding with 6-methoxy-2-naphthylacetic acid[J]. Eur J Drug Metab Pharmacokinet, 2016, 41(2): 179-186. DOI: 10.1007/s13318-014-0248-z.

23.Park JY, Hong JH, Yu J, et al. Effect of ketorolac on the prevention of postoperative catheter-related bladder discomfort in patients undergoing robot-assisted laparoscopic radical prostatectomy: a randomized, double-blinded, placebo-controlled study[J]. J Clin Med, 2019, 8(6): 759. DOI: 10.3390/jcm8060759.

24.Angelico P, Guarneri L, Velasco C, et al. Effect of cyclooxygenase inhibitors on the micturition reflex in rats: correlation with inhibition of cyclooxygenase isozymes[J]. BJU Int, 2006, 97(4): 837-846. DOI: 10.1111/j.1464-410X.2006.06003.x.

25.Antunes-Lopes T, Carvalho-Barros S, Cruz CD, et al. Biomarkers in overactive bladder: a new objective and noninvasive tool?[J]. Adv Urol, 2011, 2011: 382431. DOI: 10.1155/2011/382431.