Effect of an Intravenous Acetaminophen/Ibuprofen Fixed-Dose Combination on Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Pilot Study

Background and Objectives: Catheter-related bladder discomfort (CRBD) commonly arises as a direct consequence of perioperative urinary catheterization. A fixed dose combination of 1000mg acetaminophen and 300mg ibuprofen provides multimodal analgesia. Accordingly, we assessed the impact of this fixed dose combination on mitigating CRBD in patients undergoing urological procedures. Materials and Methods: In this prospective pilot study, 23 patients undergoing urological surgery requiring urinary catheterization were randomized into 2 groups; approximately 20 minutes before the anticipated end of surgery, patients were administered a combination of 1000 mg acetaminophen and 300 mg ibuprofen (maxigesic group, n = 11) or saline (control group, n = 12). The primary endpoint was the incidence of CRBD immediately after the patient arrived at the post-anesthetic care unit (PACU). The incidence of CRBD at 1,2,6 hours postoperatively, the severity of CRBD at each time point were also assessed. Results: The incidence of CRBD immediately after arrival at the PACU was significantly lower in the maxigesic group (54.5% vs. 100%, p = 0.014), whereas no significant differences were observed at later time points. The incidence of moderate PONV was significantly lower in the maxigesic group at 0 hour and 1hour (p = 0.036, 0.037, respectively). Conclusions: This pilot study indicates that intravenous acetaminophen and ibuprofen could be an effective, well-tolerated strategy for mitigating early postoperative CRBD in urological surgery. While these preliminary results are promising, larger randomized trials are warranted to validate the clinical efficacy of this multimodal regimen.