title: Effect of glycopyrrolate versus atropine coadministered with neostigmine for reversal of rocuronium on postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor: a prospective randomized study.
abstract: BACKGROUND
  Muscarinic receptors are involved in the mechanism of postoperative catheter-related bladder discomfort (CRBD). Glycopyrrolate and atropine as adjuncts to reversal of neuromuscular blockers have differential inhibitory effects on muscarinic receptors. This study was conducted to compare the effect of glycopyrrolate versus atropine on postoperative CRBD in patients undergoing transurethral resection of a bladder tumor (TURBT).
  
  
  METHODS
  Seventy-four patients undergoing TURBT were randomly allocated to receive either glycopyrrolate 10 μg/kg (glycopyrrolate group, n = 37) or atropine 15 μg/kg (atropine group, n = 37) in combination with neostigmine 25 μg/kg at the end of surgery for reversal of neuromuscular blockade. The incidence and severity (mild/moderate/severe) of CRBD were assessed at 0, 1, 6, and 24 h postoperatively. Tramadol 50-100 mg was administered intravenously if the patients complained of moderate or severe CRBD.
  
  
  RESULTS
  The incidence of CRBD was significantly lower in the glycopyrrolate group than in the atropine group at 0 h (65 % vs. 89 %, p = 0.025) and 1 h (54 % vs. 89 %, p = 0.002) postoperatively. The severity of postoperative CRBD was less severe in the glycopyrrolate group than in the atropine group at 0 h (p = 0.013) and 1 h (p = 0.006). Fewer patients required tramadol in the glycopyrrolate group than in the atropine group (3 % vs. 12 %, p = 0.024).
  
  
  CONCLUSIONS
  Glycopyrrolate as an adjunct to reversal of neuromuscular blockers decreased the incidence of early postoperative CRBD and postoperative tramadol requirements in patients undergoing TURBT when compared to atropine.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Hyun-Chang
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Sun-Min
authors.initials: SM
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Hyungseok
authors.initials: H
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. hppark@snu.ac.kr.
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
mesh_terms: D000368:Aged; D000732:Androstanols / Q000008:administration & dosage*; D001285:Atropine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006024:Glycopyrrolate / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage*; D019148:Neuromuscular Blockade / Q000379:methods; D011184:Postoperative Period; D011446:Prospective Studies; D000077123:Rocuronium; D014147:Tramadol / Q000008:administration & dosage; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D062885:Urinary Catheters
chemical_list: D000732:Androstanols; D009388:Neostigmine; D014147:Tramadol; D001285:Atropine; D006024:Glycopyrrolate; D000077123:Rocuronium
keywords: Atropine; Catheter-related bladder discomfort; Glycopyrrolate; Transurethral resection of bladder tumor