An Evaluation of the Efficacy of Gabapentin for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study Anil Agarwal, MD* Sanjay Dhiraaj, MD* Sandeep Pawar, MD* Rakesh Kapoor, McH† Devendra Gupta, MD* Prabhat K. Singh, MD* BACKGROUND: Catheter-related bladder discomfort (CRBD) secondary to catheter- ization of urinary bladder is distressing. In the present study, we evaluated gabapentin for preventing CRBD. METHODS: One-hundred and eight consecutive adult patients, ASA physical status I and II, of either sex, undergoing elective percutaneous nephrolithotomy were randomized into two groups of 54 each. Group control: placebo and group G gabapentin: gabapentin 600 mg. Drugs were administered orally 1 h before surgery. After induction of anesthesia, patients were catheterized with a 16F Foley catheter and the balloon was inflated with 10 mL normal saline. In the postanes- thesia care unit, the incidence and severity (mild, moderate, and severe) of CRBD were assessed on arrival (0) and at 1, 2, and 6 h. RESULTS: Gabapentin reduced the incidence of CRBD to 50% (27 of 54) compared with 80% (43 of 54) observed in the control group (P  0.05). Gabapentin also reduced the severity of CRBD and postoperative pain as observed by a reduction in the number of patients requiring any fentanyl and the total fentanyl consump- tion postoperatively (P  0.05). CONCLUSION: Gabapentin (600 mg) administered orally 1 h before surgery reduced the incidence and severity of CRBD, postoperative pain, number of patients requiring fentanyl and postoperative total fentanyl requirement. (Anesth Analg 2007;105:1454 –7) Catheter-related bladder discomfort (CRBD) sec- ondary to an indwelling urinary catheter is very distressing. It is not unusual that patients who have been catheterized under anesthesia complain of an urge to void in the postoperative period because of catheter-related bladder irritation. Symptoms of CRBD secondary to an indwelling urinary catheter mimic those of an overactive bladder (OAB) i.e., urinary frequency, urgency, with or without urge incontinence. Recently, antimuscarinic drugs, such as tolterodine and oxybutynin, have been tried for prevention of CRDB with variable success (1,2). Ketamine in sub- hypnotic doses has been reported to be an effective treatment modality for CRBD (3). Gabapentin has been reported to be effective in the treatment of resistant cases of OAB (4). As the symp- toms of OAB are similar to CRBD, in the present study, we evaluated the efficacy of gabapentin for prevention of CRBD in the postoperative period in patients undergoing catheterization of the urinary bladder intraoperatively. METHODS After approval from the Institute’s ethical committee and written informed consent from the patients; 108 ASA physical status I and II patients of either sex, undergoing elective percutaneous nephrolithotomy for renal and upper ureteric stones requiring catheterization of the urinary bladder, were included in this prospective, randomized, double-blind, placebo-controlled study. The reported incidence of bladder discomfort secondary to intraoperative catheterization is 60% (2), and presum- ing that after therapy it would decrease to 25%, power analysis with   0.05 and   0.95 showed that we would need to enroll 50 patients for each group. To minimize the effect of data loss, we recruited 54 patients in each group. Exclusion criteria were age (60 yr, chronic opioid use, bladder outflow obstruction, transurethral resection of the prostate for benign prostatic hyperplasia, OAB (frequency 3 times in the night or 8 times in 24 h), neurogenic bladder, diabetes mellitus, Parkinson’s disease, or end-stage renal disease (urine output 500 mL/24 h). From the Departments of *Anesthesia and †Surgical Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Luc- know, India. Accepted for publication July 5, 2007. Address correspondence and reprint requests to Anil Agarwal, MD, Department of Anesthesia, Type IV/48, SGPGIMS, Lucknow 226 014, India. Address e-mail to aagarwal@sgpgi.ac.in. Copyright © 2007 International Anesthesia Research Society DOI: 10.1213/01.ane.0000281154.03887.2b Vol. 105, No. 5, November 2007 1454