The urodynamic effects of intravenous opioids and ketoprofen in humans.
We used a double-blind design to study urodynamic changes induced by mu-agonists (fentanyl, morphine), a partial mu-agonist antagonist (buprenorphine), a putative mu-antagonist, kappa-agonist (nalbuphine), and ketoprofen, an injectable nonsteroidal antiinflammatory drug. Men (20-55 yr old) were randomly assigned to receive one of the following i.v. before anesthesia for endoscopic extraction of a ureteral stone: 10 mg of morphine, 0.3 mg of buprenorphine, 0.35 mg of fentanyl, 20 mg of nalbuphine, 100 mg of ketoprofen, or 10 mL of 0.9% sodium chloride. The urodynamic study consisted of cystometry followed by urethral pressure profile. Measurements were taken before the i.v. infusion of drugs and 15 min thereafter. Statistical comparisons were performed by using analysis of variance with repeated measurements (P < 0.05). Ketoprofen and saline did not induce any urodynamic changes. Opioids altered bladder sensations, and the residual volume after voiding increased, except after morphine. Detrusor contraction decreased only after the administration of fentanyl and buprenorphine. Some patients could not micturate after receiving morphine, fentanyl, and buprenorphine. Compliance and urethral pressures did not change with any drug. This study suggests that ketoprofen and nalbuphine are useful analgesics in terms of their urodynamics.


CONCLUSIONS
We compared the urodynamic effects of opioids and ketoprofen used as analgesics in surgical patients. In contrast to ketoprofen, opioids altered urodynamics. The opioid nalbuphine had no effect on detrusor contraction. This study suggests that ketoprofen and nalbuphine are useful analgesics in terms of their urodynamics.
Department of Anesthesiology, Hôtel-Dieu, Nantes, France. jmmalino@sante.univ-nantes.fr
J M
JM
Malinovsky
L
L
Le Normand
J Y
JY
Lepage
M
M
Malinge
A
A
Cozian
M
M
Pinaud
J M
JM
Buzelin
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D002047:Buprenorphine / Q000494:pharmacology; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007262:Infusions, Intravenous; D007660:Ketoprofen / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000494:pharmacology; D009266:Nalbuphine / Q000008:administration & dosage / Q000494:pharmacology; D009292:Narcotic Antagonists / Q000494:pharmacology; D014521:Urethra / Q000187:drug effects / Q000503:physiopathology; D001743:Urinary Bladder / Q000187:drug effects / Q000502:physiology; D014554:Urination / Q000187:drug effects; D014563:Urodynamics / Q000187:drug effects*
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009292:Narcotic Antagonists; D002047:Buprenorphine; D009020:Morphine; D007660:Ketoprofen; D009266:Nalbuphine; D005283:Fentanyl