Efficacy of suprapubic hot compress in preventing emergence agitation in patients with indwelling urinary catheters under general anesthesia: a randomized controlled trial.

Abstract

Purpose: Catheter-related bladder discomfort (CRBD), a major trigger of emergence agitation (EA), is common in patients with indwelling urinary catheters under general anesthesia, with limited effective non-pharmacological options. This study evaluated whether suprapubic hot compress reduces CRBD and EA in this population.

Methods: In this prospective single-center randomized controlled trial, elective surgery patients with intraoperative urinary catheterization were randomly assigned to the hot compress group or control group. The intervention group received 20 min of continuous suprapubic hot compress at 40-50 °C postoperatively; controls received an identical room-temperature placebo pack at the same site. The primary outcome was CRBD score (4-point scale, assessed at 30 min and 2 h after awakening). Secondary outcomes included EA incidence (Riker Sedation-Agitation Scale ≥ 5), comfort score, shivering, awakening duration, urine output, and catheter-related complications.

Results: A total of 217 patients were included (109 in hot compress group, 108 in controls). CRBD scores at 30 min and 2 h were significantly lower in the hot compress group (both P < 0.001). EA incidence was 7.3% in the intervention group versus 56.5% in controls (P < 0.001). Hot compress improved post-extubation comfort scores at 20 min and 2 h (both P < 0.001) and reduced shivering incidence (0% vs 7.4%, P = 0.011). No significant between-group differences were found in awakening duration, urine output, or 24-h catheter-related complications.

Conclusion: Suprapubic hot compress relieves CRBD symptoms, reduces EA incidence, improves early postoperative comfort, and prevents shivering after general anesthesia. This simple, safe non-pharmacological intervention is suitable for widespread clinical use.