Effect of Esketamine on Catheter-Related Bladder Discomfort in Elderly Male Patients Undergoing Flexible Ureteroscopic Lithotripsy After General Anesthesia.

Abstract

Purpose: Postoperative catheter-related bladder discomfort (CRBD) is a common complication in elderly male patients after intraoperative urinary catheterization. This research seeks to investigate if the intraoperative administration of esketamine can decrease the incidence and severity of CRBD and compare the effects of esketamine dosages of 0.2 and 0.5 mg/kg.

Design: A prospective randomized controlled trial.

Methods: This randomized controlled study involved 90 elderly male patients undergoing elective ureteroscopic lithotripsy. Patients were divided into three groups (n = 30 each). The low-dose group (L group) received 0.2 mg/kg esketamine intravenously before catheterization, the normal-dose group (N group) received 0.5 mg/kg esketamine, and the control group (C group) received an equivalent volume of normal saline. CRBD incidence and severity were assessed at 2, 4, 24, and 48 hours postoperatively. Secondary outcomes included extubation time, time to alertness, and physiological parameters (heart rate, blood pressure, oxygen saturation, and Mini-mental State Examination [MMSE] scores) over the same periods.

Findings: The L group showed reduced CRBD incidence at 48 hours and lower CRBD severity at all time points compared to the C group (P < .05). The N group demonstrated less severe CRBD at 2 and 48 hours compared to the C group (P < .05). Comparatively, the L group experienced milder pain at 4 and 24 hours and a lower CRBD incidence at 24 hours compared to the N group (P < .05). No significant differences were observed in other outcomes (P > .05).

Conclusions: Intravenous esketamine effectively reduces the incidence and severity of postoperative CRBD in elderly male patients undergoing ureteroscopic lithotripsy. A subanesthetic dose (0.2 mg/kg) demonstrates superior efficacy compared to an anesthetic dose (0.5 mg/kg), offering a safer and more effective strategy for managing CRBD.