Optimizing butorphanol-dexmedetomidine dosing for managing catheter-related bladder discomfort post-anesthesia: a randomized trial

Catheter-related bladder discomfort (CRBD) during anesthesia recovery increases postoperative risks and healthcare burden. This single-center randomised controlled trial evaluated the efficacy and safety of three regimens: DSF (dexmedetomidine 0.2 µg/kg plus sufentanil 0.1 µg/kg), DLB (dexmedetomidine 0.2 µg/kg plus butorphanol 10 µg/kg), and DHB (dexmedetomidine 0.2 µg/kg plus butorphanol 20 µg/kg), for managing moderate-to-severe CRBD in 102 adult patients. Primary outcomes measured CRBD severity scores and response rates (score of ≤ 1), while secondary outcomes assessed haemodynamic stability, respiratory depression, analgesia, sedation, and other parameters. Results demonstrated significant CRBD reduction across all groups post-intervention (P < 0.001). At 15 min, the dexmedetomidine-butorphanol groups achieved markedly higher response rates (DLB: 83.3%; DHB: 65.6%) than the dexmedetomidine-sufentanil group (DSF: 23.5%, P < 0.0001). The DLB group exhibited superior haemodynamic stability, avoiding heart rate fluctuations observed in DSF and DHB, along with a lower respiratory depression (13.9% vs. 41.2% in DSF, P = 0.0103). Additionally, DLB provided enhanced postoperative analgesia (lower NRS scores vs. DSF, P < 0.05) and reduced oversedation rates (52.8% at 5 min vs. 82.4% in DSF and 81.3% in DHB, P < 0.05). The findings suggest that combining 0.2 µg/kg dexmedetomidine with 10 µg/kg butorphanol offers rapid, effective CRBD relief alongside improved postoperative analgesia, while minimising sedation and respiratory risks. This regimen presents a safer strategy for CRBD during anaesthesia recovery. Trial registration: Chinese Clinical Trial Registry, identifier: ChiCTR2400091174, Date: 22/10/2024.