Bladder instillation cocktail for preventing catheter-related bladder irritation after gynecologic surgery: a double-blind, randomized, placebo- controlled study

Bladder instillation cocktail for preventing catheter-related bladder irritation after gynecologic surgery: a double-blind, randomized, placebo- controlled study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bladder instillation cocktail for preventing catheter-related bladder irritation after gynecologic surgery: a double-blind, randomized, placebo- controlled study Yuwen Liu, Xiangying Zheng, Tao Wei, Yajuan Gu, Chao Deng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5982473/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Catheter-related bladder discomfort (CRBD) can lead to decreased patient satisfaction and increased postoperative adverse events. Although existing prevention methods for CRBD have demonstrated certain therapeutic effects, they may cause various adverse reactions. In this study, a "cocktail" reagent containing a combination of three drugs, including ropivacaine, dexamethasone, and magnesium sulfate, was used. This study aimed to investigate whether bladder instillation of a "cocktail" can prevent postoperative CRBD in gynecological patients. Methods: This double-blind, prospective, randomized controlled clinical study included 112 patients randomly divided into two groups: 56 patients in the "cocktail" group and 56 patients in the control group. Patients in the "cocktail" group received an intravesical infusion of the "cocktail" ("cocktail" formula included 20 mL of 1% ropivacaine + 5 g of magnesium sulfate injection + 10 mg of dexamethasone, all diluted to a total volume of 32 mL), while those in the control group received an intravesical infusion of 32 mL of physiological saline. After bladder instillation in all patients, the catheter was clamped for 20 min. The CRBD and visual analog scale (VAS) of the patients were recorded at 0, 1, 2, and 6 h after surgery. The 15-item Quality of Recovery (QoR-15) scale was used 24 h after surgery to assess the patient's postoperative recovery status. Results: The "cocktail" group exhibited significantly decreased CRBD severity at 0, 1, 2, and 6 h postoperatively ( P = 0.002, P < 0.001, P < 0.001, and P < 0.001, respectively). Specifically, compared with the control group, the "cocktail" group exhibited a significant decrease in moderate-to-severe CRBD at 0, 1, and 2 h postoperatively ( P = 0.040, P = 0.043, P = 0.031, respectively). Moreover, patients in the "cocktail" group exhibited significantly higher postoperative recovery scale scores compared to those in the control group ( P < 0.001). Conclusion: Bladder instillation of the "cocktail" can prevent catheter-related bladder irritation and improve postoperative recovery in gynecologic patients. Trial registration: This trial was a retrospective registration with the Chinese Clinical Trial Registry (No. ChiCTR2300078550), registered on December 12, 2023. Intravesical instillation Catheter-related bladder discomfort Gynecologic surgery Figures Figure 1 Figure 2 Figure 3 Background Catheter-related bladder discomfort (CRBD) is among the primary causes of emergency agitation in patients during the awakening period of general anesthesia. It is characterized by obvious lower abdominal distension, urgency, painful urination, and restlessness, which can lead to decreased patient satisfaction and increased incidence of postoperative complications, including incision rupture, wound bleeding, catheter dislodgement, hemodynamic instability, and induction of heart disease [ 1 ]. Some studies have reported the incidence of CRBD between 47% and 90% [ 1 – 3 ]. Therapeutic drugs currently used in clinical practice include tramadol [ 4 ], ketamine [ 5 ], ketorolac [ 6 ], dexmedetomidine [ 7 , 8 ], anticholinergic drugs [ 9 , 10 ], nerve blocks [ 11 ], and others. Although these therapeutic methods have a certain degree of efficacy for CRBD, they are often associated with various adverse reactions, including nausea and vomiting, dry mouth, blurred vision, respiratory depression, hypotension, excessive sedation, and pelvic floor muscle weakness. Therefore, there is currently no ideal method to prevent CRBD. Catheterization and indwelling catheterization are the primary causes of discomfort in patients with CRBD. These catheterizations mechanically stimulate the bladder and urethra, damaging their mucosa and leading to pain, inflammation, and detrusor muscle spasms. These spasms result in discomfort, such as lower abdominal distension, urgency, and pain during urination. Ropivacaine, a long-acting amide local anesthetic with long duration and low toxicity, can be used for surface anesthesia; dexamethasone can inhibit the production of inflammatory products, thus playing an anti-inflammatory role; magnesium sulfate can competitively inhibit calcium ion activity during neurotransmitter transmission, thus playing an antispasmodic role. Given the characteristics of these three drugs, we hypothesized that their combined administration may effectively prevent CRBD occurrence following general anesthesia. Intravesical drug delivery (IDD) therapy involves the direct administration of drugs into the bladder via a catheter, allowing the drugs to rapidly attain an effective concentration on the bladder epithelium to prevent and treat diseases. IDD offers the advantages of high local drug concentrations and low systemic toxicity and side effects. This therapy was initially used in bladder cancer treatment through chemotherapeutic drug infusion to prevent tumor recurrence and metastasis and has since been widely used to treat various bladder disorders, including interstitial cystitis, overactive bladder, bladder cancer, and CRBD [ 12 – 14 ]. In this study, we propose combining three drugs—ropivacaine, magnesium sulfate, and dexamethasone—to form a "cocktail" for bladder instillation, aiming to provide a reference for preventing CRBD after general anesthesia. Methods and materials Study design This study is a double-blind, randomized, placebo-controlled trial, which was approved by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University on 1 December 2023 (No. KJ2023-388-01). This trial was registered at the Chinese Clinical Trial Registry on December 12, 2023 (No. ChiCTR2300078550), and the study protocol followed the CONSORT guidelines. All participants provided written informed consent. This study enrolled gynecological patients undergoing laparoscopic or open surgery at the First Affiliated Hospital of Shihezi University between December 2023 and July 2024. The inclusion criteria were as follows: patients aged 18–70 years; classified as American Society of Anesthesiologists (ASA) grades I–III; underwent catheterization for the first time; had no contraindications to the use of ropivacaine, magnesium sulfate, and dexamethasone. All patients provided voluntary consent to participate in the study. The exclusion criteria included the following: patients with multiple failed catheterizations and urethral anatomical abnormalities, bladder outflow tract obstruction, neurogenic bladder, interstitial cystitis, painful bladder syndrome, overactive bladder, or the presence of psychiatric or communication disorders. Grouping and processing A stratified block randomization method was used to create blocks (number of 2, length of 4, ratio 1:1) using the type of surgery as the stratification factor. The blocks were randomized using a computerized random number method, and eligible participants were assigned to groups based on the order obtained. The first investigator conducted the randomization and prepared the study drug, the "cocktail" or saline. The study drugs were delivered to the second investigator in visually identical syringes. The second investigator performed bladder instillation and clamped the catheter for 20 min before anesthesia awakening. A third investigator collected data from the postanesthesia care unit (PACU) and wards. Only the first investigator was aware of the grouping, whereas the other investigators and patients were blinded. To minimize the risk of bias, the predetermined randomization code was strictly followed throughout the study. One day before surgery, the patients were educated on identifying CRBD symptoms, including suprapubic discomfort, urgency, painful urination, sensations of urination, and others, and distinguishing CRBD from surgical pain. After inducing general anesthesia, experienced nurses performed catheterization using a Fr16 triple-lumen urinary catheter, inflating the balloon with 10 mL of physiological saline for each patient. Patients in the "cocktail" group received a retrograde bladder instillation of the "cocktail" through the catheter before anesthesia awakening, and the catheter was clamped for 20 min. The "cocktail" formula contained 20 mL of 1% ropivacaine (Ruiyang Pharmaceutical Co., Ltd, China), 5 g of magnesium sulfate injection (Yangzhou Zhongbao Pharmaceutical Co., Ltd, China), and 10 mg of dexamethasone (Hubei Tianyao Pharmaceutical Co., Ltd, China), totaling 32 mL. Patients in the control group received 32 mL of physiological saline through retrograde bladder instillation via the urinary catheter, and the catheter was clamped for 20 min before anesthesia awakening. The degree of CRBD and wound pain of patients were assessed at 0, 1, 2, and 6 h after surgery. The severity of CRBD is classified as follows: if the patient does not report any discomfort in the urethra and bladder even when questioned, it is "none"; if the patient only complains of discomfort only when questioned, it is "mild"; if the patient independently reports discomfort related to the urethra without any behavior, it is "moderate"; if the patient independently reports and has behavioral reactions such as strong language reactions, limb movements, and attempts to remove the catheter, it is "severe". Postoperative pain was assessed using the visual analog scale (VAS), expressed as 0–100 mm, with 0 mm indicating no pain and 100 mm indicating the most intense pain. The 15-item Quality of Recovery (QoR-15) scale was used 24 h after surgery to assess the patient's postoperative recovery status. Postoperative safety indicators were also collected for both groups, including postoperative nausea and vomiting, headache, facial flushing, sweating, dry mouth, itchy skin, and systemic toxicity of ropivacaine (seizures, bradycardia, sensory abnormalities, and others). In the PACU and the ward, tramadol was used as a remedial analgesic. For patients reporting moderate or severe CRBD or with a VAS score ≥ 40 mm at the surgical site, 1 mg/kg tramadol was administered and reassessed. Tramadol could be administered twice daily. Anesthesia method After the patient entered the operating room, venous access was established, and standard anesthesia monitoring was performed, including pulse oximetry, noninvasive blood pressure monitoring, electrocardiography, end-tidal carbon dioxide, and bispectral index evaluation (BIS). Anesthesia was administered following a uniform protocol. Under spontaneous breathing conditions, the patient inhaled pure oxygen at a flow rate of 5 L/min for 5 min. Anesthesia was induced by intravenous injection of 0.03 mg/kg midazolam, 0.5 μg/kg sufentanil, 2–2.5 mg/kg propofol, and 0.6 mg/kg rocuronium bromide. Oral endotracheal intubation and mechanical ventilation were performed after the patient's consciousness and spontaneous breathing disappeared. Respiratory parameters were adjusted to an inhaled gas flow of 1–2 L/min, oxygen concentration of 60%, tidal volume of 6–8 mL/kg, respiratory rate of 12–14 breaths/min, inspiratory expiratory ratio of 1:2, pressure of end-expiratory carbon dioxide maintained at 35–45 mmHg, SpO 2 > 95%, and peak airway pressure no more than 30 cmH 2 O. An intraoperative BIS of 40–60 was maintained with intravenous pumping of 4–12 mg/kg/h propofol and 0.2–0.3 μg/kg/min remifentanil. Additional rocuronium bromide was administered intermittently during the operation to maintain the appropriate depth of inotropic relaxation until the inotropic medication was discontinued 30 min before the end of the operation. Before suturing, 5 μg of sufentanil was administered intravenously; intravenous propofol and remifentanil were discontinued at the end of suturing. Before transferring the patient to the PACU, 4 mg/kg of sugammadex sodium was administered to reverse neuromuscular blockade. Sample size estimate The sample size of this study was calculated using the PASS software (version 15; NCSS, LLC, USA). Based on previous literature, the incidence of moderate or severe CRBD ranges from 45% to 67% [13,15]. In this study, it was predicted that the bladder instillation of the "cocktail" could reduce this incidence to 25%–30%. With a statistical power of 90% and a two-sided significance level of 0.05, the sample size was calculated to be 53 patients per group. Considering a 10% loss of follow-up rate, 60 patients were required in each group to test for statistical significance, and a total of 120 subjects participated in the study. The patients were assigned to the experimental and control groups. Statistical analysis Statistical analysis was performed using the Statistical Package for the Social Sciences software (version 21.0; IBM Corporation, USA). For normally distributed measurement data, the statistical results are expressed as mean ± standard deviation, and a two-sample t-test was used to compare the two groups. Measurement data that did not conform to a normal distribution are expressed as medians and interquartile ranges and compared using non-parametric tests. Enumeration data are expressed as frequency (n) and percentage (%), and group comparisons were conducted using chi-square or Fisher’s exact test. Statistical significance was set at P < 0.05. Results A total of 419 gynecological patients scheduled to undergo laparoscopic or open surgery were included in this study. Of these, 307 patients were excluded for various reasons, leaving 56 patients in the "cocktail" group and 56 patients in the control group who completed the study (Fig. 1). Demographic data of the patients, including age, body mass index, ASA grade, were collected. We also recorded surgery-related data, including surgery type, anesthesia duration, surgical duration, and tracheal extubation time after surgery. After surgery, we collected the patients’ indwelling catheter duration and total length of hospital stay. There were no statistically significant differences between the two groups regarding demographic and surgery-related data (Table 1). Table 1. Demographics and surgery-related data. Control Group (n=56) "Cocktail" Group (n=56) P -Value Age, years 47.09±10.83 47.45±10.55 0.860 Body mass index, kg/m2 23.73[21.91-26.31] 24.58[22.53-26.16] 0.248 ASA classification I/II/III 7/49/0 6/50/0 0.768 Operation time (min) 95.5[70-116.5] 88[72-108.75] 0.512 Anesthesia time(min) 103[82-130] 100[82.75-116.5] 0.395 Extubation time (min) 11[8-15] 11[7-15] 0.525 ASA: American society of anesthesiologists Comparison of CRBD incidence between the two groups There were significant differences in the severity of CRBD between the "cocktail" group and the control group at 0, 1, 2, and 6 h after surgery ( P = 0.002, P < 0.001, P < 0.001, and P < 0.001, respectively) (Table 2). To determine the effectiveness of the "cocktail" bladder instillation method in preventing CRBD, we compared the incidence of moderate or severe CRBD between the two groups at 0, 1, 2, and 6 h postoperatively. The results revealed a significant reduction in moderate or severe CRBD in the "cocktail" group compared to the control group at 0, 1, and 2 h after surgery (5 [8.9%] versus 13 [23.2%], P = 0.040; 6 [10.7%] versus 14 [25.0%], P = 0.043; 4 [7.1%] versus 12 [21.4%], P = 0.031). This reduction persisted up to 1–2 h after surgery. Although the number of cases of moderate or severe CRBD in the "cocktail" group was lower than that in the control group at 6 h (2 [3.6%] versus 6 [10.7%], P = 0.271), this difference was not clinically significant (Fig. 2 ). Table 2. Comparison of postoperative CRBD grades between the control and "cocktail" groups. Control Group (n=56) "Cocktail" Group (n=56) P - Value 0 h postoperatively 0.002 None 15(26.8%) 30(53.6%) Mild 28(50.0%) 21(37.5%) Moderate 11(19.6%) 4(7.1%) Severe 2(3.6%) 1(1.8%) 1 h postoperatively <0.001 None 6(10.7%) 25(44.6%) Mild 36(64.3%) 25(44.6%) Moderate 14(25.0%) 6(10.7%) Severe 0(0.0%) 0(0.0%) 2 h postoperatively <0.001 None 8(14.3%) 25(44.6%) Mild 36(64.3%) 27(48.2%) Moderate 12(21.4%) 4(7.1%) Severe 0(0.0%) 0(0.0%) 6 h postoperatively <0.001 None 20(35.7%) 42(75.0%) Mild 30(53.6%) 12(21.4%) Moderate 6(10.7%) 2(3.6%) Severe 0(0.0%) 0(0.0%) Comparison of postoperative pain and rescue analgesia between the two groups No significant difference was observed between the "cocktail" group and the control group in terms of postoperative pain ( P = 0.376, P = 0.462, P = 0.450 and P = 0.318, respectively). Statistically different frequency of rescue analgesia within 24h after surgery in the "cocktail" group and the control group ( P = 0.019) (Table 3) Table 3. Comparison of VAS scores and rescue analgesia in the control and "cocktail" groups Control group (n=56) "Cocktail" Group (n=56) P - Value Postoperative VAS score 0h 24[21-31] 30[20-32] 0.376 1h 29[23-31] 30[21-32] 0.462 2h 30[23-32] 28[22-32] 0.450 6h 28[21-31] 24[22-29] 0.318 Number of Rescue analgesic 0.019 0 22(39.3%) 32(57.1%) 1 15(26.8%) 16(28.6%) 2 19(33.9%) 8(14.3%) VAS: Visual analog scale Comparison of postoperative recovery in the two groups Patients in the "cocktail" group exhibited significantly higher postoperative recovery scale scores compared to those in the control group (130[125-133.75] versus 121[112.25-125], P <0.001) (Fig.3). Additionally, there were no significant differences between the two groups regarding the length of hospital stay, indwelling catheter duration, or postoperative adverse reactions (Table 4). No adverse reactions associated with ropivacaine, dexamethasone, or magnesium sulfate were observed in the study patients, including systemic toxicity, skin itching, facial flushing, sweating, dry mouth, or respiratory depression. All patients were discharged without any other clinical complications. Table.4. Comparison of hospitalization duration, indwelling catheter duration, and adverse reactions between two groups Control Group (n=56) "Cocktail" Group (n=56) P - Value Duration of indwelling catheter, hours 52.5[26.0-71.5] 49.5[25.0-70.8] 0.623 Hospital stay, days 9[8-12] 8[7-11] 0.226 Postoperative nausea/vomiting 19(33.92%) 18(32.14%) 0.841 Adverse reactions related to "cocktail" 0(0%) 0(0%) >0.999 Discussion Our study observed that the "cocktail" bladder instillation significantly reduced CRBD severity at 0, 1, 2, and 6 h and the incidence of moderate or severe CRBD at 0, 1, and 2 h after gynecologic laparoscopic and open surgery. In addition, patients in the "cocktail" group exhibited significantly higher postoperative 24-h recovery scores than those in the control group. The frequency of rescue analgesia in the "cocktail" group was lower than in the control group in the first 24h after surgery. However, no significant differences were observed between the two groups regarding postoperative pain. Moreover, no adverse reactions associated with the "cocktail" reagent were observed. In this study, the incidence of CRBD at 0 h postoperatively in the control group was 73.2%, and that of moderate or severe CRBD was 23.2%, similar to that reported in other studies [ 2 , 16 , 17 ]. However, the incidence of moderate or severe CRBD was lower, which might be because our study subjects were females compared to other relevant studies that mostly included males or were gender-neutral. The high incidence of CRBD in male patients may be attributed to anatomical features such as urethral stricture and elongation, as well as the prevalence of prostate hyperplasia in middle-aged and elderly people. We selected patients undergoing gynecological laparoscopic or open surgery under elective general anesthesia as the study population. Studies have indicated that obstetric and gynecological surgeries, laparoscopic or open procedures, and other procedures are predictive factors for CRBD [ 18 – 20 ]. Anatomically, the female uterus is adjacent to the bladder, and manipulation of the uterus during laparoscopic or open surgery is likely to irritate the bladder [ 21 , 22 ]. Surgical procedures such as hysterectomy involve tissues surrounding the bladder, which can damage the bladder nerves, main ligaments, and pelvic nerve plexus, leading to bladder paralysis [ 21 – 23 ]. In obstetric and gynecological surgeries, postoperative pain at the surgical site near the bladder may also exacerbate CRBD [ 19 ]. The "cocktail" reagent used in this study comprised three drugs, including ropivacaine, magnesium sulfate, and dexamethasone. Ropivacaine, along with other local anesthetics, paralyzes the bladder mucosa by inactivating sodium channels in the cell membrane, thereby inhibiting the transmission of pain signals from the bladder to the brain [ 24 , 25 ]. Although randomized controlled trials evaluating the effects of lidocaine and bupivacaine flushing on CRBD are limited, these agents have demonstrated a preventive effect against CRBD occurrence, albeit for a short duration [ 26 , 27 ]. Ropivacaine is the first pure levameric long-acting amide local anesthetic, which is now widely used in clinical practice for nerve block and analgesia. Pharmacokinetic studies have found that ropivacaine has a lower central nervous system and cardiovascular system toxicity, greater hemodynamic stability, and a favorable safety profile compared with bupivacaine [ 28 ]. Although lidocaine is also suitable for surface anesthesia owing to its wide dispersion and high penetration, its shorter duration of action limits its efficacy in relieving postoperative CRBD [ 29 ]. Ropivacaine has a longer action time than lidocaine, and studies have found that it can provide 2–12 h of surface anesthesia [ 30 , 31 ]. Moreover, ropivacaine has a substantial sensory-motor blocking dissociation effect at low concentrations, with a high clearance rate and vasoconstrictive properties, making it suitable for postoperative local analgesia [ 28 ]. Previous studies have confirmed the effectiveness of ropivacaine for surface anesthesia; it is commonly used to prevent stress reactions during tracheal intubation and extubation, as well as oral mucosal surface anesthesia [ 30 , 32 ]. Although ropivacaine use in the "cocktail" formulation is theoretically anticipated to prolong analgesia, our results demonstrated a significant difference ( P < 0.001) in the severity of CRBD between the two groups at 6 h after surgery. However, no statistically significant difference was observed in the occurrence of moderate-to-severe CRBD between the two groups at 6 h after surgery (2 [3.6%] versus 6 [10.7%], P = 0.271). Dexamethasone has good anti-inflammatory effects. Mucosal injury caused by catheterization and prolonged catheter presence may contribute to CRBD development. One possible mechanism is that mucosal injury activates phospholipase A2, which causes arachidonic acid release. The released arachidonic acid is then processed by the cyclooxygenase (COX) pathway to produce inflammatory mediators such as prostaglandins and leukotrienes, leading to local inflammatory reactions such as pain. Previous studies have found that bladder inflammation can cause CRBD [ 15 , 33 ]. Dexamethasone is a long-acting injectable formulation of glucocorticoids that belongs to the class of steroidal anti-inflammatory drugs commonly used to treat inflammatory pain. Dexamethasone inhibits intracellular phospholipases, which inhibit the production of arachidonic acid, which has an anti-inflammatory effect. Moreover, regarding bladder perfusion, dexamethasone can effectively inhibit the inflammatory response of the bladder mucosa and reduce the symptoms of bladder irritation. Dexamethasone is commonly used as an anesthetic adjuvant [ 34 , 35 ]. During local anesthesia, it promotes the absorption of other anesthetic drugs into tissues, improving their penetration and prolonging their duration of action [ 35 ]. Mechanical stimulation of the catheter causes parasympathetic and somatic motor nerve excitation, leading to involuntary contraction of the detrusor muscle, which is also a cause of CRBD. Magnesium ions are smooth muscle relaxants that can competitively inhibit calcium ion activity in neurotransmitter transmission, thereby reducing neurotransmitter release and affecting the normal function of neuromuscular junctions. This weakens the depolarization of acetylcholine at the endplate and reduces the muscle fiber membrane excitability, leading to smooth muscle relaxation and spasmolytic effects [ 36 ]. Studies have found that the intravenous injection of magnesium sulfate effectively prevents CRBD [ 37 ]; however, its intravenous application may cause adverse reactions, including fever, flushing, and sweating. Rapid administration or a high concentration of intravenous injection may lead to serious complications, such as hypotension, respiratory depression, and bradycardia. Considering these potential adverse effects and complications, bladder instillation of magnesium sulfate may be a safer alternative for CRBD prevention. During the 24-h follow-up period, QoR-15 was used to evaluate postoperative recovery in the two groups. The minimum clinical difference in QoR-15 scores is currently considered to be 6 or 8 points [ 38 , 39 ], and the median difference observed between the two groups in the present trial was 9, which was statistically significant (130 [125–133.75] versus 121 [112.25–125], P < 0.001). These results indicate better postoperative recovery in patients who received the "cocktail" bladder instillations. Besides, no statistically significant difference was observed between the two groups in VAS at various time points recorded, indicating that the localized effects of the bladder instillation of the "cocktail" did not have a systemic effect on pain and sedation. There was a statistical difference in 24-h postoperative rescue analgesia between the two groups ( P = 0.019), probably mainly due to the different severity of CRBD in the two groups. Regarding drug dosage selection, no study has established the maximum safe dose of ropivacaine for surface anesthesia. Accordingly, we referred to a maximum safe dose of 200 mg ropivacaine for local infiltration anesthesia and nerve block procedures. We referred to the dosage of dexamethasone as an anesthetic adjuvant as well as the dosage for the treatment of CRBD and finally chose dexamethasone 10 mg [ 34 , 40 ]. Magnesium sulfate, typically administered at a dosage of 2.5–5 g, is used to relieve smooth muscle spasmodic pain [ 41 , 42 ]. Therefore, we chose 200 mg of 1% ropivacaine + 5 g of magnesium sulfate injection + 10 mg of dexamethasone for bladder instillation. In our study, no adverse effects associated with bladder instillation of the "cocktail" were observed, such as facial flushing, sweating, dry mouth, skin itching, or systemic toxicity of ropivacaine. Moreover, no postoperative bladder dysfunction was associated with the intravesical "cocktail", and the difference in the duration of the indwelling catheter between the two groups was non-significant (49.5 [25.0–70.8] versus 52.5 [26.0–71.5], P = 0.623). This study has some limitations that should be addressed. First, all participants were ASA class I–II, elective surgical patients aged 18–70 years, generally in good health. Consequently, critically ill patients and those aged > 70 years were excluded from the study. Second, although the "cocktail" formula is theoretically expected to have a longer duration of action, this was not observed in our study, which may be due to the timing of the follow-up visits in our trial design. Including follow-up visits between 2 and 6 h after surgery may provide a more accurate evaluation of the duration of the "cocktail" effect. Third, this was a single-center study with a small number of cases; ultimately, only 112 patients were enrolled, and the occurrence of rare adverse reactions was not observed. In future studies, large sample sizes and multi-center clinical validation are essential. Conclusions In conclusion, the bladder instillation of the "cocktail" can prevent CRBD and improve postoperative recovery after gynecological general anesthesia. Our results suggest that this "cocktail" bladder instillation may be an effective strategy to prevent CRBD following general anesthesia. Abbreviations CRBD: Catheter-related bladder discomfort; VAS: Visual analog scale; IDD: Intravesical drug delivery; ASA: American Society of Anesthesiologists; PACU: Postanesthesia care unit; QoR-15: 15-item Quality of Recovery; BIS: Bispectral index evaluation Declarations Ethics approval and consent to participate: This study was approved by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University on 1 December 2023 (Ethical Review Number: KJ2023-388-01). All participants provided written informed consent. Consent for publication: Not applicable . Availability of data and materials: The datasets used and analyzed during this current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This work was supported by the Bureau of Science and Technology, China, No.2022ZD037 and No.2022ZD077. Authors' contributions: Study design: YL, XZ, CD. Study conduct: YL, XZ, TW, YG. Data analysis: YL, XZ, CD. Writing paper: YL, XZ, TW, YG, CD. All authors read and approved the final manuscript. Acknowledgements: We are very grateful to our colleagues in the Department of Anesthesiology of the First Affiliated Hospital of Shihezi University for their help. In addition, we would like to express our gratitude to the patients and their families who participated in this study for their active cooperation. References Y B, X W, X L, C P, H Y, Y T, et al. Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. Journal of endourology. 2015 Jun [cited 2023 Oct 11];29(6). Binhas M, Motamed C, Hawajri N, Yiou R, Marty J. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim. 2011 Feb;30(2):122–5. Bala I, Bharti N, Chaubey VK, Mandal AK. Efficacy of gabapentin for prevention of postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor. Urology. 2012 Apr;79(4):853–7. Agarwal A, Yadav G, Gupta D, Singh PK, Singh U. Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study. Br J Anaesth. 2008 Oct;101(4):506–10. Lu Y, Li Q, Wang Y, Zhou Z, Zhang D, Bao Y, et al. Meta-Analysis of the Efficacy and Safety of Ketamine on Postoperative Catheter-Related Bladder Discomfort. Front Pharmacol. 2022;13:816995. Park JY, Hong JH, Yu J, Kim DH, Koh GH, Lee SA, et al. Effect of Ketorolac on the Prevention of Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Randomized, Double-Blinded, Placebo-Controlled Study. J Clin Med. 2019 May 29;8(6). Singh TK, Sahu S, Agarwal A, Gupta D, Mishra P. Dexmedetomidine for prevention of early postoperative catheter-related bladder discomfort in voluntary kidney donors: Prospective, randomized, double-blind, placebo-controlled trial. J Anaesthesiol Clin Pharmacol. 2018 Jun;34(2):211–5. Kwon Y, Jang JS, Hwang SM, Lee JJ, Tark H. Intraoperative administration of dexmedetomidine reduced the postoperative catheter-related bladder discomfort and pain in patients undergoing lumbar microdiscectomy. J Anesth. 2018 Feb;32(1):41–7. Nam K, Seo JH, Ryu JH, Oh AY, Lee T, Park HP, et al. Randomized, clinical trial on the preventive effects of butylscopolamine on early postoperative catheter-related bladder discomfort. Surgery. 2015 Feb;157(2):396–401. Sabetian G, Zand F, Asadpour E, Ghorbani M, Adibi P, Hosseini MM, et al. Evaluation of hyoscine N-butyl bromide efficacy on the prevention of catheter-related bladder discomfort after transurethral resection of prostate: a randomized, double-blind control trial. Int Urol Nephrol. 2017 Nov;49(11):1907–13. Tsuchiya M, Kyoh Y, Mizutani K, Yamashita J, Hamada T. Ultrasound-guided single shot caudal block anesthesia reduces postoperative urinary catheter-induced discomfort. Minerva Anestesiol. 2013 Dec;79(12):1381–8. Jones G, Cleves A, Wilt TJ, Mason M, Kynaston HG, Shelley M. Intravesical gemcitabine for non-muscle invasive bladder cancer. Cochrane Database Syst Rev. 2012 Jan 18;1:CD009294. Chen H, Wang B, Li Q, Zhou J, Li R, Zhang Y. Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study. BMC Anesthesiol. 2020 Oct 22;20(1):267. Pournajafian A, Ghodraty MR, Shafighnia S, Rokhtabnak F, Khatibi A, Tavoosian S, et al. The Effect of Intravesical Diluted Bupivacaine on Catheter-Related Bladder Discomfort in Young and Middle-Aged Male Patients During Postanaesthetic Recovery. Turk J Anaesthesiol Reanim. 2020 Dec;48(6):454–9. Park JY, Baek JW, Yu J, Kim CS, Bae J, Kim YK. Vitamin C and catheter-related bladder discomfort after transurethral resection of bladder tumor: A double-blind, randomized, placebo-controlled study. J Clin Anesth. 2023 Oct;89:111191. Agarwal A, Dhiraaj S, Singhal V, Kapoor R, Tandon M. Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth. 2006 Mar;96(3):377–80. Bai Y, Wang X, Li X, Pu C, Yuan H, Tang Y, et al. Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. J Endourol. 2015 Jun;29(6):640–9. Li C, Liu Z, Yang F. Predictors of catheter-related bladder discomfort after urological surgery. J Huazhong Univ Sci Technolog Med Sci. 2014 Aug;34(4):559–62. Li SY, Song LP, Ma YS, Lin XM. Predictors of catheter-related bladder discomfort after gynaecological surgery. BMC Anesthesiol. 2020 Apr 28;20(1):97. Lim N, Yoon H. Factors Predicting Catheter-Related Bladder Discomfort in Surgical Patients. J Perianesth Nurs. 2017 Oct;32(5):400–8. Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013 Mar;121(3):654–73. Ramdhan RC, Loukas M, Tubbs RS. Anatomical complications of hysterectomy: A review. Clin Anat. 2017 Oct;30(7):946–52. [Chinese expert consensus on nerve-sparing radical hysterectomy for cervical cancer]. Zhonghua Zhong Liu Za Zhi. 2021 Jul 23;43(7):736–42. Fozzard HA, Sheets MF, Hanck DA. The sodium channel as a target for local anesthetic drugs. Front Pharmacol. 2011;2:68. Ahrens J, Leffler A. [Update on the pharmacology and effects of local anesthetics]. Anaesthesist. 2014 May;63(5):376–86. Moeen AM. Editorial Comment on Transurethral lidocaine (100 mg) bladder irrigation (TULI100) reduces the incidence of catheter-related bladder discomfort in TURBT: A randomized, double-blind, controlled trial. Int J Urol. 2023 Mar;30(3):270–1. Lin CH, Lu IC, Gau TP, Cheng KI, Chen HL, Hu PY. Preventing Postoperative Catheter-Related Bladder Discomfort (CRBD) with Bladder Irrigation Using 0.05% Lidocaine Saline Solution: Monitoring with Analgesia Nociception Index (ANI) after Transurethral Surgery. Medicina (Kaunas). 2024 Aug 27;60(9). Casati A, Santorsola R, Cerchierini E, Moizo E. Ropivacaine. Minerva Anestesiol. 2001 Sep;67(9 Suppl 1):15–9. Kim DH, Park JY, Yu J, Lee SA, Park S, Hwang JH, et al. Intravenous Lidocaine for the Prevention of Postoperative Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized, Double-Blind, Controlled Trial. Anesth Analg. 2020 Jul;131(1):220–7. Fang P, Zong Z, Lu Y, Han X, Liu X. Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia: a prospective randomized double-blind controlled study. BMC Anesthesiol. 2018 Sep 27;18(1):134. Niu J, Hu R, Yang N, He Y, Sun H, Ning R, et al. Effect of intratracheal dexmedetomidine combined with ropivacaine on postoperative sore throat: a prospective randomised double-blinded controlled trial. BMC Anesthesiol. 2022 May 14;22(1):144. Franz-Montan M, Silva ALR, Cogo K, Bergamaschi C de C, Volpato MC, Ranali J, et al. Liposome-encapsulated ropivacaine for topical anesthesia of human oral mucosa. Anesth Analg. 2007 Jun;104(6):1528–31, table of contents. Ergenoglu P, Akin S, Yalcin Cok O, Eker E, Kuzgunbay B, Turunc T, et al. Effect of intraoperative paracetamol on catheter-related bladder discomfort: a prospective, randomized, double-blind study. Curr Ther Res Clin Exp. 2012 Dec;73(6):186–94. Zufferey PJ, Chaux R, Lachaud PA, Capdevila X, Lanoiselée J, Ollier E. Dose-response relationships of intravenous and perineural dexamethasone as adjuvants to peripheral nerve blocks: a systematic review and model-based network meta-analysis. Br J Anaesth. 2024 May;132(5):1122–32. Zhang S, Song M, An W, Wang Z. Effects of different doses of dexamethasone as local anesthetic adjuvant on brachial plexus block: A protocol for systematic review and meta analysis. Medicine (Baltimore). 2021 Apr 30;100(17):e25651. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015 Sep 23;7(9):8199–226. Shim JW, Cha S, Moon HW, Moon YE. Effects of Intraoperative Magnesium and Ketorolac on Catheter-Related Bladder Discomfort after Transurethral Bladder Tumor Resection: A Prospective Randomized Study. J Clin Med. 2022 Oct 27;11(21). Marty P, Chassery C, Rontes O, Vuillaume C, Basset B, Merouani M, et al. Obturator nerve block does not provide analgesic benefits in total hip arthroplasty under multimodal analgesic regimen: a randomized controlled trial. Reg Anesth Pain Med. 2021 Aug;46(8):657–62. Kukreja P, Uppal V, Kofskey AM, Feinstein J, Northern T, Davis C, et al. Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. Br J Anaesth. 2023 Jun;130(6):773–9. Cho SA, Huh I, Lee SJ, Sung TY, Ku GW, Cho CK, et al. Effects of dexamethasone on catheter-related bladder discomfort and emergence agitation: a prospective, randomized, controlled trial. Korean J Anesthesiol. 2022 Feb;75(1):71–8. Deng J, Peng L, Wang Y, Li J, Tang L, Yu Y. Population pharmacokinetics and dose optimization of magnesium sulfate in Chinese preeclampsia population. BMC Pregnancy Childbirth. 2024 Jun 13;24(1):424. Zolfaghari Sadrabad A, Azimi Abarghouei S, Farahmand Rad R, Salimi Y. Intravenous magnesium sulfate vs. morphine sulfate in relieving renal colic: A randomized clinical trial. Am J Emerg Med. 2021 Aug;46:188–92. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5982473","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":415405337,"identity":"8aea4910-e9d3-4f03-a4dc-1dc963e5c0d3","order_by":0,"name":"Yuwen Liu","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Yuwen","middleName":"","lastName":"Liu","suffix":""},{"id":415405338,"identity":"f00a04b5-308d-4eab-8ced-972e42ed7b14","order_by":1,"name":"Xiangying Zheng","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Xiangying","middleName":"","lastName":"Zheng","suffix":""},{"id":415405339,"identity":"d9ab1445-3d69-459c-9763-8d13701c5d16","order_by":2,"name":"Tao Wei","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Wei","suffix":""},{"id":415405340,"identity":"1c9f7fd4-05c6-4683-9ee1-7f7349c0e54e","order_by":3,"name":"Yajuan Gu","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Yajuan","middleName":"","lastName":"Gu","suffix":""},{"id":415405341,"identity":"167dac32-6fd9-4177-bac6-f5bf86323546","order_by":4,"name":"Chao Deng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDCCA0AsYWDDY9/e2PjwA/FaCtJkDHgONxtLEK2F4cNhGwOJ9DYBHmJ08B0/fk3CwoCZx1zyYRuDBIOdnG4DAS2SZ3LKJCQM2HgsZye2PShgSDY2O0BAi8ENnjSgFh4ehtuJ7QYSDAcStxGpRYKH4ebBNiBJlBb2Y0AtBjwGNxiJ1AL0C7OFhEECj2RPIjCQDYjwCzDEHt6W+PPfnp/9+MOHHyrs5AhqYWDgMZFGxKABQeUgwP74I3HpZBSMglEwCkYsAADM/UGTZd8McwAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":true,"prefix":"","firstName":"Chao","middleName":"","lastName":"Deng","suffix":""}],"badges":[],"createdAt":"2025-02-07 15:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5982473/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5982473/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76572572,"identity":"50c9b24e-fd45-46bd-bf76-3ff0eb673177","added_by":"auto","created_at":"2025-02-18 13:51:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27495,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram. CRBD, catheter-related bladder discomfort.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5982473/v1/65c92d0806b3aaee3a5e3c0e.png"},{"id":76574621,"identity":"56ed2dda-48ba-4abe-9b5b-6a88ecb9dcf8","added_by":"auto","created_at":"2025-02-18 14:07:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53416,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of moderate or severe CRBD incidence between the \"cocktail\" group andthe control group at 0, 1, 2, and 6 h postoperatively.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5982473/v1/c9a6a488fa338f5dfc8e51b9.png"},{"id":76573730,"identity":"9678c545-c955-4489-8ae4-2da746ade5c4","added_by":"auto","created_at":"2025-02-18 13:59:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28372,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of postoperative recovery between the \"cocktail\" and control groups. Postoperative recovery was assessed using the QoR-15 scale.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5982473/v1/24937e7814814c5a265efd73.png"},{"id":81978752,"identity":"9cd14233-d340-466a-aba7-3af787bf7fae","added_by":"auto","created_at":"2025-05-05 14:09:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":832134,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5982473/v1/f2373f88-f5f4-4cb4-8690-8a3f38df55d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bladder instillation cocktail for preventing catheter-related bladder irritation after gynecologic surgery: a double-blind, randomized, placebo- controlled study","fulltext":[{"header":"Background","content":"\u003cp\u003eCatheter-related bladder discomfort (CRBD) is among the primary causes of emergency agitation in patients during the awakening period of general anesthesia. It is characterized by obvious lower abdominal distension, urgency, painful urination, and restlessness, which can lead to decreased patient satisfaction and increased incidence of postoperative complications, including incision rupture, wound bleeding, catheter dislodgement, hemodynamic instability, and induction of heart disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Some studies have reported the incidence of CRBD between 47% and 90% [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therapeutic drugs currently used in clinical practice include tramadol [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], ketamine [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], ketorolac [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], dexmedetomidine [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], anticholinergic drugs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], nerve blocks [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and others. Although these therapeutic methods have a certain degree of efficacy for CRBD, they are often associated with various adverse reactions, including nausea and vomiting, dry mouth, blurred vision, respiratory depression, hypotension, excessive sedation, and pelvic floor muscle weakness. Therefore, there is currently no ideal method to prevent CRBD.\u003c/p\u003e \u003cp\u003eCatheterization and indwelling catheterization are the primary causes of discomfort in patients with CRBD. These catheterizations mechanically stimulate the bladder and urethra, damaging their mucosa and leading to pain, inflammation, and detrusor muscle spasms. These spasms result in discomfort, such as lower abdominal distension, urgency, and pain during urination. Ropivacaine, a long-acting amide local anesthetic with long duration and low toxicity, can be used for surface anesthesia; dexamethasone can inhibit the production of inflammatory products, thus playing an anti-inflammatory role; magnesium sulfate can competitively inhibit calcium ion activity during neurotransmitter transmission, thus playing an antispasmodic role. Given the characteristics of these three drugs, we hypothesized that their combined administration may effectively prevent CRBD occurrence following general anesthesia.\u003c/p\u003e \u003cp\u003eIntravesical drug delivery (IDD) therapy involves the direct administration of drugs into the bladder via a catheter, allowing the drugs to rapidly attain an effective concentration on the bladder epithelium to prevent and treat diseases. IDD offers the advantages of high local drug concentrations and low systemic toxicity and side effects. This therapy was initially used in bladder cancer treatment through chemotherapeutic drug infusion to prevent tumor recurrence and metastasis and has since been widely used to treat various bladder disorders, including interstitial cystitis, overactive bladder, bladder cancer, and CRBD [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we propose combining three drugs\u0026mdash;ropivacaine, magnesium sulfate, and dexamethasone\u0026mdash;to form a \"cocktail\" for bladder instillation, aiming to provide a reference for preventing CRBD after general anesthesia.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a double-blind, randomized, placebo-controlled trial, which was approved by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University on 1 December 2023 (No. KJ2023-388-01). This trial was registered at the Chinese Clinical Trial Registry on December 12, 2023 (No. ChiCTR2300078550), and the study protocol followed the CONSORT guidelines. All participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003eThis study enrolled gynecological patients undergoing laparoscopic or open surgery at the First Affiliated Hospital of Shihezi University between December 2023 and July 2024. The inclusion criteria were as follows: patients aged 18\u0026ndash;70 years; classified as American Society of Anesthesiologists (ASA) grades I\u0026ndash;III; underwent catheterization for the first time; had no contraindications to the use of ropivacaine, magnesium sulfate, and dexamethasone. All patients provided voluntary consent to participate in the study. The exclusion criteria included the following: patients with multiple failed catheterizations and urethral anatomical abnormalities, bladder outflow tract obstruction, neurogenic bladder, interstitial cystitis, painful bladder syndrome, overactive bladder, or the presence of psychiatric or communication disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrouping and processing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA stratified block randomization method was used to create blocks (number of 2, length of 4, ratio 1:1) using the type of surgery as the stratification factor. The blocks were randomized using a computerized random number method, and eligible participants were assigned to groups based on the order obtained. The first investigator conducted the randomization and prepared the study drug, the \u0026quot;cocktail\u0026quot; or saline. The study drugs were delivered to the second investigator in visually identical syringes. The second investigator performed bladder instillation and clamped the catheter for 20 min before anesthesia awakening. A third investigator collected data from the postanesthesia care unit (PACU) and wards. Only the first investigator was aware of the grouping, whereas the other investigators and patients were blinded. To minimize the risk of bias, the predetermined randomization code was strictly followed throughout the study.\u003c/p\u003e\n\u003cp\u003eOne day before surgery, the patients were educated on identifying CRBD symptoms, including suprapubic discomfort, urgency, painful urination, sensations of urination, and others, and distinguishing CRBD from surgical pain. After inducing general anesthesia, experienced nurses performed catheterization using a Fr16 triple-lumen urinary catheter, inflating the balloon with 10 mL of physiological saline for each patient. Patients in the \u0026quot;cocktail\u0026quot; group received a retrograde bladder instillation of the \u0026quot;cocktail\u0026quot; through the catheter before anesthesia awakening, and the catheter was clamped for 20 min. The \u0026quot;cocktail\u0026quot; formula contained 20 mL of 1% ropivacaine (Ruiyang Pharmaceutical Co., Ltd, China), 5 g of magnesium sulfate injection (Yangzhou Zhongbao Pharmaceutical Co., Ltd, China), and 10 mg of dexamethasone (Hubei Tianyao Pharmaceutical Co., Ltd, China), totaling 32 mL. Patients in the control group received 32 mL of physiological saline through retrograde bladder instillation via the urinary catheter, and the catheter was clamped for 20 min before anesthesia awakening.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe degree of CRBD and wound pain of patients were assessed at 0, 1, 2, and 6 h after surgery. The severity of CRBD is classified as follows: if the patient does not report any discomfort in the urethra and bladder even when questioned, it is \u0026quot;none\u0026quot;; if the patient only complains of discomfort only when questioned, it is \u0026quot;mild\u0026quot;; if the patient independently reports discomfort related to the urethra without any behavior, it is \u0026quot;moderate\u0026quot;; if the patient independently reports and has behavioral reactions such as strong language reactions, limb movements, and attempts to remove the catheter, it is \u0026quot;severe\u0026quot;. Postoperative pain was assessed using the visual analog scale (VAS), expressed as 0\u0026ndash;100 mm, with 0 mm indicating no pain and 100 mm indicating the most intense pain. The 15-item Quality of Recovery (QoR-15) scale was used 24 h after surgery to assess the patient\u0026apos;s postoperative recovery status. Postoperative safety indicators were also collected for both groups, including postoperative nausea and vomiting, headache, facial flushing, sweating, dry mouth, itchy skin, and systemic toxicity of ropivacaine (seizures, bradycardia, sensory abnormalities, and others). In the PACU and the ward, tramadol was used as a remedial analgesic. For patients reporting moderate or severe CRBD or with a VAS score \u0026ge; 40 mm at the surgical site, 1 mg/kg tramadol was administered and reassessed. Tramadol could be administered twice daily.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnesthesia method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the patient entered the operating room, venous access was established, and standard anesthesia monitoring was performed, including pulse oximetry, noninvasive blood pressure monitoring, electrocardiography, end-tidal carbon dioxide, and bispectral index evaluation (BIS). Anesthesia was administered following a uniform protocol. Under spontaneous breathing conditions, the patient inhaled pure oxygen at a flow rate of 5 L/min for 5 min. Anesthesia was induced by intravenous injection of 0.03 mg/kg midazolam, 0.5 \u0026mu;g/kg sufentanil, 2\u0026ndash;2.5 mg/kg propofol, and 0.6 mg/kg rocuronium bromide. Oral endotracheal intubation and mechanical ventilation were performed after the patient\u0026apos;s consciousness and spontaneous breathing disappeared. Respiratory parameters were adjusted to an inhaled gas flow of 1\u0026ndash;2 L/min, oxygen concentration of 60%, tidal volume of 6\u0026ndash;8 mL/kg, respiratory rate of 12\u0026ndash;14 breaths/min, inspiratory expiratory\u0026nbsp;ratio of 1:2, pressure of end-expiratory carbon dioxide maintained at 35\u0026ndash;45 mmHg, SpO\u003csub\u003e2\u003c/sub\u003e \u0026gt; 95%, and peak airway pressure no more than 30 cmH\u003csub\u003e2\u003c/sub\u003eO.\u003c/p\u003e\n\u003cp\u003eAn intraoperative BIS of 40\u0026ndash;60 was maintained with intravenous pumping of 4\u0026ndash;12 mg/kg/h propofol and 0.2\u0026ndash;0.3 \u0026mu;g/kg/min remifentanil. Additional rocuronium bromide was administered intermittently during the operation to maintain the appropriate depth of inotropic relaxation until the inotropic medication was discontinued 30 min before the end of the operation. Before suturing, 5 \u0026mu;g of sufentanil was administered intravenously; intravenous propofol and remifentanil were discontinued at the end of suturing. Before transferring the patient to the PACU, 4 mg/kg of sugammadex sodium was administered to reverse neuromuscular blockade.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size estimate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size of this study was calculated using the PASS software (version 15; NCSS, LLC, USA). Based on previous literature, the incidence of moderate or severe CRBD ranges from 45% to 67%\u0026nbsp;[13,15]. In this study, it was predicted that the bladder instillation of the \u0026quot;cocktail\u0026quot; could reduce this incidence to 25%\u0026ndash;30%. With a statistical power of 90% and a two-sided significance level of 0.05, the sample size was calculated to be 53 patients per group. Considering a 10% loss of follow-up rate, 60 patients were required in each group to test for statistical significance, and a total of 120 subjects participated in the study. The patients were assigned to the experimental and control groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using the Statistical Package for the Social Sciences software (version 21.0; IBM Corporation, USA). For normally distributed measurement data, the statistical results are expressed as mean \u0026plusmn; standard deviation, and a two-sample t-test was used to compare the two groups. Measurement data that did not conform to a normal distribution are expressed as medians and interquartile ranges and compared using non-parametric tests. Enumeration data are expressed as frequency (n) and percentage (%), and group comparisons were conducted using chi-square or Fisher\u0026rsquo;s exact test. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 419 gynecological patients scheduled to undergo laparoscopic or open surgery were included in this study. Of these, 307 patients were excluded for various reasons, leaving 56 patients in the \u0026quot;cocktail\u0026quot; group and 56 patients in the control group who completed the study (Fig. 1). Demographic data of the patients, including age, body mass index, ASA grade, were collected. We also recorded surgery-related data, including surgery type, anesthesia duration, surgical duration, and tracheal extubation time after surgery. After surgery, we collected the patients\u0026rsquo; indwelling catheter duration and total length of hospital stay. There were no statistically significant differences between the two groups regarding demographic and surgery-related data (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Demographics and surgery-related data.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7545%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e\u0026quot;Cocktail\u0026quot; Group\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6209%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7545%;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e47.09\u0026plusmn;10.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e47.45\u0026plusmn;10.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.6209%;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7545%;\"\u003e\n \u003cp\u003eBody mass index, kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e23.73[21.91-26.31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e24.58[22.53-26.16]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.6209%;\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7545%;\"\u003e\n \u003cp\u003eASA classification I/II/III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e7/49/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e6/50/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.6209%;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7545%;\"\u003e\n \u003cp\u003eOperation time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e95.5[70-116.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e88[72-108.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.6209%;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7545%;\"\u003e\n \u003cp\u003eAnesthesia time(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e103[82-130]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e100[82.75-116.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.6209%;\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.7545%;\"\u003e\n \u003cp\u003eExtubation time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e11[8-15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8123%;\"\u003e\n \u003cp\u003e11[7-15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.6209%;\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eASA: American society of anesthesiologists\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of CRBD incidence between the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003etwo groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were significant differences in the severity of CRBD between the \u0026quot;cocktail\u0026quot; group and the control group at 0, 1, 2, and 6 h after surgery (\u003cem\u003eP\u003c/em\u003e = 0.002, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, and \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, respectively) (Table 2). To determine the effectiveness of the \u0026quot;cocktail\u0026quot; bladder instillation method in preventing CRBD, we compared the incidence of moderate or severe CRBD between the two groups at 0, 1, 2, and 6 h postoperatively. The results revealed a significant reduction in moderate or severe CRBD in the \u0026quot;cocktail\u0026quot; group compared to the control group at 0, 1, and 2 h after surgery (5 [8.9%] versus 13 [23.2%], \u003cem\u003eP\u003c/em\u003e = 0.040; 6 [10.7%] versus 14 [25.0%], \u003cem\u003eP\u003c/em\u003e = 0.043; 4 [7.1%] versus 12 [21.4%], \u003cem\u003eP\u003c/em\u003e = 0.031). This reduction persisted up to 1\u0026ndash;2 h after surgery. Although the number of cases of moderate or severe CRBD in the \u0026quot;cocktail\u0026quot; group was lower than that in the control group at 6 h (2 [3.6%] versus 6 [10.7%], \u003cem\u003eP\u003c/em\u003e = 0.271), this difference was not clinically significant (Fig. \u003ca href=\"#bookmark1\"\u003e2\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eComparison of postoperative CRBD grades between the control and\u0026nbsp;\u0026quot;cocktail\u0026quot;\u0026nbsp;groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eControl Group\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026quot;Cocktail\u0026quot; Group\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e0 h postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e15(26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e30(53.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e28(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e21(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e11(19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e4(7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e2(3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e1(1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e1 h postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e6(10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e25(44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e36(64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e25(44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e14(25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e6(10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e2 h postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e8(14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e25(44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e36(64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e27(48.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e12(21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e4(7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e6 h postoperatively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e20(35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e42(75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e30(53.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e12(21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e6(10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e2(3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.3056%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0832%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of postoperative pain and rescue analgesia between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo significant difference was observed between the \u0026quot;cocktail\u0026quot; group and the control group in terms of postoperative pain (\u003cem\u003eP\u003c/em\u003e = 0.376, \u003cem\u003eP\u003c/em\u003e = 0.462, \u003cem\u003eP\u003c/em\u003e = 0.450 and \u003cem\u003eP\u003c/em\u003e = 0.318, respectively). Statistically different frequency of rescue analgesia within 24h after surgery in the \u0026quot;cocktail\u0026quot; group and the control group (\u003cem\u003eP\u003c/em\u003e = 0.019) (Table 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Comparison of VAS scores and rescue analgesia in the control and \u0026quot;cocktail\u0026quot; groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003eControl group\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e\u0026quot;Cocktail\u0026quot; Group\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003ePostoperative VAS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e0h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e24[21-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e30[20-32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e1h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e29[23-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e30[21-32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e2h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e30[23-32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e28[22-32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e6h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e28[21-31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e24[22-29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003eNumber of Rescue analgesic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e22(39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e32(57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e15(26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e16(28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.8047%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e19(33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.774%;\"\u003e\n \u003cp\u003e8(14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.6474%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eVAS:\u0026nbsp;Visual analog scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of postoperative recovery in the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients in the \u0026quot;cocktail\u0026quot; group exhibited significantly higher postoperative recovery scale scores compared to those in the control group (130[125-133.75] versus 121[112.25-125], \u003cem\u003eP\u003c/em\u003e \u0026lt;0.001) (Fig.3). Additionally, there were no significant differences between the two groups regarding the length of hospital stay, indwelling catheter duration, or postoperative adverse reactions (Table 4). No adverse reactions associated with ropivacaine, dexamethasone, or magnesium sulfate were observed in the study patients, including systemic toxicity, skin itching, facial flushing, sweating, dry mouth, or respiratory depression. All patients were discharged without any other clinical complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable.4.\u003c/strong\u003e Comparison of hospitalization duration, indwelling catheter duration, and adverse reactions between two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.6739%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003eControl Group\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e\u0026quot;Cocktail\u0026quot; Group\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8623%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.6739%;\"\u003e\n \u003cp\u003eDuration of indwelling catheter, hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e52.5[26.0-71.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e49.5[25.0-70.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8623%;\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.6739%;\"\u003e\n \u003cp\u003eHospital stay, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e9[8-12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e8[7-11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8623%;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.6739%;\"\u003e\n \u003cp\u003ePostoperative nausea/vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e19(33.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e18(32.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8623%;\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.6739%;\"\u003e\n \u003cp\u003eAdverse reactions related to \u0026quot;cocktail\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7319%;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8623%;\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study observed that the \"cocktail\" bladder instillation significantly reduced CRBD severity at 0, 1, 2, and 6 h and the incidence of moderate or severe CRBD at 0, 1, and 2 h after gynecologic laparoscopic and open surgery. In addition, patients in the \"cocktail\" group exhibited significantly higher postoperative 24-h recovery scores than those in the control group. The frequency of rescue analgesia in the \"cocktail\" group was lower than in the control group in the first 24h after surgery. However, no significant differences were observed between the two groups regarding postoperative pain. Moreover, no adverse reactions associated with the \"cocktail\" reagent were observed.\u003c/p\u003e \u003cp\u003eIn this study, the incidence of CRBD at 0 h postoperatively in the control group was 73.2%, and that of moderate or severe CRBD was 23.2%, similar to that reported in other studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, the incidence of moderate or severe CRBD was lower, which might be because our study subjects were females compared to other relevant studies that mostly included males or were gender-neutral. The high incidence of CRBD in male patients may be attributed to anatomical features such as urethral stricture and elongation, as well as the prevalence of prostate hyperplasia in middle-aged and elderly people. We selected patients undergoing gynecological laparoscopic or open surgery under elective general anesthesia as the study population. Studies have indicated that obstetric and gynecological surgeries, laparoscopic or open procedures, and other procedures are predictive factors for CRBD [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Anatomically, the female uterus is adjacent to the bladder, and manipulation of the uterus during laparoscopic or open surgery is likely to irritate the bladder [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Surgical procedures such as hysterectomy involve tissues surrounding the bladder, which can damage the bladder nerves, main ligaments, and pelvic nerve plexus, leading to bladder paralysis [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In obstetric and gynecological surgeries, postoperative pain at the surgical site near the bladder may also exacerbate CRBD [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe \"cocktail\" reagent used in this study comprised three drugs, including ropivacaine, magnesium sulfate, and dexamethasone. Ropivacaine, along with other local anesthetics, paralyzes the bladder mucosa by inactivating sodium channels in the cell membrane, thereby inhibiting the transmission of pain signals from the bladder to the brain [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Although randomized controlled trials evaluating the effects of lidocaine and bupivacaine flushing on CRBD are limited, these agents have demonstrated a preventive effect against CRBD occurrence, albeit for a short duration [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Ropivacaine is the first pure levameric long-acting amide local anesthetic, which is now widely used in clinical practice for nerve block and analgesia. Pharmacokinetic studies have found that ropivacaine has a lower central nervous system and cardiovascular system toxicity, greater hemodynamic stability, and a favorable safety profile compared with bupivacaine [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Although lidocaine is also suitable for surface anesthesia owing to its wide dispersion and high penetration, its shorter duration of action limits its efficacy in relieving postoperative CRBD [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Ropivacaine has a longer action time than lidocaine, and studies have found that it can provide 2\u0026ndash;12 h of surface anesthesia [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Moreover, ropivacaine has a substantial sensory-motor blocking dissociation effect at low concentrations, with a high clearance rate and vasoconstrictive properties, making it suitable for postoperative local analgesia [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Previous studies have confirmed the effectiveness of ropivacaine for surface anesthesia; it is commonly used to prevent stress reactions during tracheal intubation and extubation, as well as oral mucosal surface anesthesia [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Although ropivacaine use in the \"cocktail\" formulation is theoretically anticipated to prolong analgesia, our results demonstrated a significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the severity of CRBD between the two groups at 6 h after surgery. However, no statistically significant difference was observed in the occurrence of moderate-to-severe CRBD between the two groups at 6 h after surgery (2 [3.6%] versus 6 [10.7%], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.271).\u003c/p\u003e \u003cp\u003eDexamethasone has good anti-inflammatory effects. Mucosal injury caused by catheterization and prolonged catheter presence may contribute to CRBD development. One possible mechanism is that mucosal injury activates phospholipase A2, which causes arachidonic acid release. The released arachidonic acid is then processed by the cyclooxygenase (COX) pathway to produce inflammatory mediators such as prostaglandins and leukotrienes, leading to local inflammatory reactions such as pain. Previous studies have found that bladder inflammation can cause CRBD [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Dexamethasone is a long-acting injectable formulation of glucocorticoids that belongs to the class of steroidal anti-inflammatory drugs commonly used to treat inflammatory pain. Dexamethasone inhibits intracellular phospholipases, which inhibit the production of arachidonic acid, which has an anti-inflammatory effect. Moreover, regarding bladder perfusion, dexamethasone can effectively inhibit the inflammatory response of the bladder mucosa and reduce the symptoms of bladder irritation. Dexamethasone is commonly used as an anesthetic adjuvant [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. During local anesthesia, it promotes the absorption of other anesthetic drugs into tissues, improving their penetration and prolonging their duration of action [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMechanical stimulation of the catheter causes parasympathetic and somatic motor nerve excitation, leading to involuntary contraction of the detrusor muscle, which is also a cause of CRBD. Magnesium ions are smooth muscle relaxants that can competitively inhibit calcium ion activity in neurotransmitter transmission, thereby reducing neurotransmitter release and affecting the normal function of neuromuscular junctions. This weakens the depolarization of acetylcholine at the endplate and reduces the muscle fiber membrane excitability, leading to smooth muscle relaxation and spasmolytic effects [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Studies have found that the intravenous injection of magnesium sulfate effectively prevents CRBD [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]; however, its intravenous application may cause adverse reactions, including fever, flushing, and sweating. Rapid administration or a high concentration of intravenous injection may lead to serious complications, such as hypotension, respiratory depression, and bradycardia. Considering these potential adverse effects and complications, bladder instillation of magnesium sulfate may be a safer alternative for CRBD prevention.\u003c/p\u003e \u003cp\u003eDuring the 24-h follow-up period, QoR-15 was used to evaluate postoperative recovery in the two groups. The minimum clinical difference in QoR-15 scores is currently considered to be 6 or 8 points [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], and the median difference observed between the two groups in the present trial was 9, which was statistically significant (130 [125\u0026ndash;133.75] versus 121 [112.25\u0026ndash;125], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results indicate better postoperative recovery in patients who received the \"cocktail\" bladder instillations. Besides, no statistically significant difference was observed between the two groups in VAS at various time points recorded, indicating that the localized effects of the bladder instillation of the \"cocktail\" did not have a systemic effect on pain and sedation. There was a statistical difference in 24-h postoperative rescue analgesia between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019), probably mainly due to the different severity of CRBD in the two groups.\u003c/p\u003e \u003cp\u003eRegarding drug dosage selection, no study has established the maximum safe dose of ropivacaine for surface anesthesia. Accordingly, we referred to a maximum safe dose of 200 mg ropivacaine for local infiltration anesthesia and nerve block procedures. We referred to the dosage of dexamethasone as an anesthetic adjuvant as well as the dosage for the treatment of CRBD and finally chose dexamethasone 10 mg [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Magnesium sulfate, typically administered at a dosage of 2.5\u0026ndash;5 g, is used to relieve smooth muscle spasmodic pain [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Therefore, we chose 200 mg of 1% ropivacaine\u0026thinsp;+\u0026thinsp;5 g of magnesium sulfate injection\u0026thinsp;+\u0026thinsp;10 mg of dexamethasone for bladder instillation. In our study, no adverse effects associated with bladder instillation of the \"cocktail\" were observed, such as facial flushing, sweating, dry mouth, skin itching, or systemic toxicity of ropivacaine. Moreover, no postoperative bladder dysfunction was associated with the intravesical \"cocktail\", and the difference in the duration of the indwelling catheter between the two groups was non-significant (49.5 [25.0\u0026ndash;70.8] versus 52.5 [26.0\u0026ndash;71.5], \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.623).\u003c/p\u003e \u003cp\u003eThis study has some limitations that should be addressed. First, all participants were ASA class I\u0026ndash;II, elective surgical patients aged 18\u0026ndash;70 years, generally in good health. Consequently, critically ill patients and those aged\u0026thinsp;\u0026gt;\u0026thinsp;70 years were excluded from the study. Second, although the \"cocktail\" formula is theoretically expected to have a longer duration of action, this was not observed in our study, which may be due to the timing of the follow-up visits in our trial design. Including follow-up visits between 2 and 6 h after surgery may provide a more accurate evaluation of the duration of the \"cocktail\" effect. Third, this was a single-center study with a small number of cases; ultimately, only 112 patients were enrolled, and the occurrence of rare adverse reactions was not observed. In future studies, large sample sizes and multi-center clinical validation are essential.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the bladder instillation of the \"cocktail\" can prevent CRBD and improve postoperative recovery after gynecological general anesthesia. Our results suggest that this \"cocktail\" bladder instillation may be an effective strategy to prevent CRBD following general anesthesia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCRBD: Catheter-related bladder discomfort; VAS: Visual analog scale; IDD: Intravesical drug delivery; ASA: American Society of Anesthesiologists; PACU: Postanesthesia care unit; QoR-15: 15-item Quality of Recovery; BIS: Bispectral index evaluation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University on 1 December 2023 (Ethical Review Number: KJ2023-388-01). All participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during this current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Bureau of Science and Technology, China, No.2022ZD037 and No.2022ZD077.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: YL, XZ, CD. Study conduct: YL, XZ, TW, YG. Data analysis: YL, XZ, CD. Writing paper: YL, XZ, TW, YG, CD. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are very grateful to our colleagues in the Department of Anesthesiology of the First Affiliated Hospital of Shihezi University for their help. In addition, we would like to express our gratitude to the patients and their families who participated in this study for their active cooperation.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eY B, X W, X L, C P, H Y, Y T, et al. Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. Journal of endourology. 2015 Jun [cited 2023 Oct 11];29(6).\u003c/li\u003e\n\u003cli\u003eBinhas M, Motamed C, Hawajri N, Yiou R, Marty J. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim. 2011 Feb;30(2):122\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eBala I, Bharti N, Chaubey VK, Mandal AK. Efficacy of gabapentin for prevention of postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of bladder tumor. Urology. 2012 Apr;79(4):853\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eAgarwal A, Yadav G, Gupta D, Singh PK, Singh U. Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study. Br J Anaesth. 2008 Oct;101(4):506\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eLu Y, Li Q, Wang Y, Zhou Z, Zhang D, Bao Y, et al. Meta-Analysis of the Efficacy and Safety of Ketamine on Postoperative Catheter-Related Bladder Discomfort. Front Pharmacol. 2022;13:816995. \u003c/li\u003e\n\u003cli\u003ePark JY, Hong JH, Yu J, Kim DH, Koh GH, Lee SA, et al. Effect of Ketorolac on the Prevention of Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Randomized, Double-Blinded, Placebo-Controlled Study. J Clin Med. 2019 May 29;8(6). \u003c/li\u003e\n\u003cli\u003eSingh TK, Sahu S, Agarwal A, Gupta D, Mishra P. Dexmedetomidine for prevention of early postoperative catheter-related bladder discomfort in voluntary kidney donors: Prospective, randomized, double-blind, placebo-controlled trial. J Anaesthesiol Clin Pharmacol. 2018 Jun;34(2):211\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eKwon Y, Jang JS, Hwang SM, Lee JJ, Tark H. Intraoperative administration of dexmedetomidine reduced the postoperative catheter-related bladder discomfort and pain in patients undergoing lumbar microdiscectomy. J Anesth. 2018 Feb;32(1):41\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eNam K, Seo JH, Ryu JH, Oh AY, Lee T, Park HP, et al. Randomized, clinical trial on the preventive effects of butylscopolamine on early postoperative catheter-related bladder discomfort. Surgery. 2015 Feb;157(2):396\u0026ndash;401. \u003c/li\u003e\n\u003cli\u003eSabetian G, Zand F, Asadpour E, Ghorbani M, Adibi P, Hosseini MM, et al. Evaluation of hyoscine N-butyl bromide efficacy on the prevention of catheter-related bladder discomfort after transurethral resection of prostate: a randomized, double-blind control trial. Int Urol Nephrol. 2017 Nov;49(11):1907\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eTsuchiya M, Kyoh Y, Mizutani K, Yamashita J, Hamada T. Ultrasound-guided single shot caudal block anesthesia reduces postoperative urinary catheter-induced discomfort. Minerva Anestesiol. 2013 Dec;79(12):1381\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eJones G, Cleves A, Wilt TJ, Mason M, Kynaston HG, Shelley M. Intravesical gemcitabine for non-muscle invasive bladder cancer. Cochrane Database Syst Rev. 2012 Jan 18;1:CD009294. \u003c/li\u003e\n\u003cli\u003eChen H, Wang B, Li Q, Zhou J, Li R, Zhang Y. Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study. BMC Anesthesiol. 2020 Oct 22;20(1):267. \u003c/li\u003e\n\u003cli\u003ePournajafian A, Ghodraty MR, Shafighnia S, Rokhtabnak F, Khatibi A, Tavoosian S, et al. The Effect of Intravesical Diluted Bupivacaine on Catheter-Related Bladder Discomfort in Young and Middle-Aged Male Patients During Postanaesthetic Recovery. Turk J Anaesthesiol Reanim. 2020 Dec;48(6):454\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003ePark JY, Baek JW, Yu J, Kim CS, Bae J, Kim YK. Vitamin C and catheter-related bladder discomfort after transurethral resection of bladder tumor: A double-blind, randomized, placebo-controlled study. J Clin Anesth. 2023 Oct;89:111191. \u003c/li\u003e\n\u003cli\u003eAgarwal A, Dhiraaj S, Singhal V, Kapoor R, Tandon M. Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth. 2006 Mar;96(3):377\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eBai Y, Wang X, Li X, Pu C, Yuan H, Tang Y, et al. Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. J Endourol. 2015 Jun;29(6):640\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLi C, Liu Z, Yang F. Predictors of catheter-related bladder discomfort after urological surgery. J Huazhong Univ Sci Technolog Med Sci. 2014 Aug;34(4):559\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eLi SY, Song LP, Ma YS, Lin XM. Predictors of catheter-related bladder discomfort after gynaecological surgery. BMC Anesthesiol. 2020 Apr 28;20(1):97. \u003c/li\u003e\n\u003cli\u003eLim N, Yoon H. Factors Predicting Catheter-Related Bladder Discomfort in Surgical Patients. J Perianesth Nurs. 2017 Oct;32(5):400\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eClarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013 Mar;121(3):654\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eRamdhan RC, Loukas M, Tubbs RS. Anatomical complications of hysterectomy: A review. Clin Anat. 2017 Oct;30(7):946\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003e[Chinese expert consensus on nerve-sparing radical hysterectomy for cervical cancer]. Zhonghua Zhong Liu Za Zhi. 2021 Jul 23;43(7):736\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eFozzard HA, Sheets MF, Hanck DA. The sodium channel as a target for local anesthetic drugs. Front Pharmacol. 2011;2:68. \u003c/li\u003e\n\u003cli\u003eAhrens J, Leffler A. [Update on the pharmacology and effects of local anesthetics]. Anaesthesist. 2014 May;63(5):376\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eMoeen AM. Editorial Comment on Transurethral lidocaine (100\u0026thinsp;mg) bladder irrigation (TULI100) reduces the incidence of catheter-related bladder discomfort in TURBT: A randomized, double-blind, controlled trial. Int J Urol. 2023 Mar;30(3):270\u0026ndash;1. \u003c/li\u003e\n\u003cli\u003eLin CH, Lu IC, Gau TP, Cheng KI, Chen HL, Hu PY. Preventing Postoperative Catheter-Related Bladder Discomfort (CRBD) with Bladder Irrigation Using 0.05% Lidocaine Saline Solution: Monitoring with Analgesia Nociception Index (ANI) after Transurethral Surgery. Medicina (Kaunas). 2024 Aug 27;60(9). \u003c/li\u003e\n\u003cli\u003eCasati A, Santorsola R, Cerchierini E, Moizo E. Ropivacaine. Minerva Anestesiol. 2001 Sep;67(9 Suppl 1):15\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKim DH, Park JY, Yu J, Lee SA, Park S, Hwang JH, et al. Intravenous Lidocaine for the Prevention of Postoperative Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized, Double-Blind, Controlled Trial. Anesth Analg. 2020 Jul;131(1):220\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eFang P, Zong Z, Lu Y, Han X, Liu X. Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia: a prospective randomized double-blind controlled study. BMC Anesthesiol. 2018 Sep 27;18(1):134. \u003c/li\u003e\n\u003cli\u003eNiu J, Hu R, Yang N, He Y, Sun H, Ning R, et al. Effect of intratracheal dexmedetomidine combined with ropivacaine on postoperative sore throat: a prospective randomised double-blinded controlled trial. BMC Anesthesiol. 2022 May 14;22(1):144. \u003c/li\u003e\n\u003cli\u003eFranz-Montan M, Silva ALR, Cogo K, Bergamaschi C de C, Volpato MC, Ranali J, et al. Liposome-encapsulated ropivacaine for topical anesthesia of human oral mucosa. Anesth Analg. 2007 Jun;104(6):1528\u0026ndash;31, table of contents. \u003c/li\u003e\n\u003cli\u003eErgenoglu P, Akin S, Yalcin Cok O, Eker E, Kuzgunbay B, Turunc T, et al. Effect of intraoperative paracetamol on catheter-related bladder discomfort: a prospective, randomized, double-blind study. Curr Ther Res Clin Exp. 2012 Dec;73(6):186\u0026ndash;94. \u003c/li\u003e\n\u003cli\u003eZufferey PJ, Chaux R, Lachaud PA, Capdevila X, Lanoisel\u0026eacute;e J, Ollier E. Dose-response relationships of intravenous and perineural dexamethasone as adjuvants to peripheral nerve blocks: a systematic review and model-based network meta-analysis. Br J Anaesth. 2024 May;132(5):1122\u0026ndash;32. \u003c/li\u003e\n\u003cli\u003eZhang S, Song M, An W, Wang Z. Effects of different doses of dexamethasone as local anesthetic adjuvant on brachial plexus block: A protocol for systematic review and meta analysis. Medicine (Baltimore). 2021 Apr 30;100(17):e25651. \u003c/li\u003e\n\u003cli\u003eGr\u0026ouml;ber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015 Sep 23;7(9):8199\u0026ndash;226. \u003c/li\u003e\n\u003cli\u003eShim JW, Cha S, Moon HW, Moon YE. Effects of Intraoperative Magnesium and Ketorolac on Catheter-Related Bladder Discomfort after Transurethral Bladder Tumor Resection: A Prospective Randomized Study. J Clin Med. 2022 Oct 27;11(21). \u003c/li\u003e\n\u003cli\u003eMarty P, Chassery C, Rontes O, Vuillaume C, Basset B, Merouani M, et al. Obturator nerve block does not provide analgesic benefits in total hip arthroplasty under multimodal analgesic regimen: a randomized controlled trial. Reg Anesth Pain Med. 2021 Aug;46(8):657\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eKukreja P, Uppal V, Kofskey AM, Feinstein J, Northern T, Davis C, et al. Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial. Br J Anaesth. 2023 Jun;130(6):773\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eCho SA, Huh I, Lee SJ, Sung TY, Ku GW, Cho CK, et al. Effects of dexamethasone on catheter-related bladder discomfort and emergence agitation: a prospective, randomized, controlled trial. Korean J Anesthesiol. 2022 Feb;75(1):71\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eDeng J, Peng L, Wang Y, Li J, Tang L, Yu Y. Population pharmacokinetics and dose optimization of magnesium sulfate in Chinese preeclampsia population. BMC Pregnancy Childbirth. 2024 Jun 13;24(1):424. \u003c/li\u003e\n\u003cli\u003eZolfaghari Sadrabad A, Azimi Abarghouei S, Farahmand Rad R, Salimi Y. Intravenous magnesium sulfate vs. morphine sulfate in relieving renal colic: A randomized clinical trial. Am J Emerg Med. 2021 Aug;46:188\u0026ndash;92. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intravesical instillation, Catheter-related bladder discomfort, Gynecologic surgery","lastPublishedDoi":"10.21203/rs.3.rs-5982473/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5982473/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCatheter-related bladder discomfort (CRBD) can lead to decreased patient satisfaction and increased postoperative adverse events. Although existing prevention methods for CRBD have demonstrated certain therapeutic effects, they may cause various adverse reactions. In this study, a \"cocktail\" reagent containing a combination of three drugs, including ropivacaine, dexamethasone, and magnesium sulfate, was used. This study aimed to investigate whether bladder instillation of a \"cocktail\" can prevent postoperative CRBD in gynecological patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis double-blind, prospective, randomized controlled clinical study included 112 patients randomly divided into two groups: 56 patients in the \"cocktail\" group and 56 patients in the control group. Patients in the \"cocktail\" group received an intravesical infusion of the \"cocktail\" (\"cocktail\" formula included 20 mL of 1% ropivacaine + 5 g of magnesium sulfate injection + 10 mg of dexamethasone, all diluted to a total volume of 32 mL), while those in the control group received an intravesical infusion of 32 mL of physiological saline. After bladder instillation in all patients, the catheter was clamped for 20 min. The CRBD and visual analog scale (VAS) of the patients were recorded at 0, 1, 2, and 6 h after surgery. The 15-item Quality of Recovery (QoR-15) scale was used 24 h after surgery to assess the patient's postoperative recovery status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe \"cocktail\" group exhibited significantly decreased CRBD severity at 0, 1, 2, and 6 h postoperatively (\u003cem\u003eP\u003c/em\u003e = 0.002, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, and \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, respectively). Specifically, compared with the control group, the \"cocktail\" group exhibited a significant decrease in moderate-to-severe CRBD at 0, 1, and 2 h postoperatively (\u003cem\u003eP\u003c/em\u003e = 0.040, \u003cem\u003eP\u003c/em\u003e = 0.043, \u003cem\u003eP\u003c/em\u003e = 0.031, respectively). Moreover, patients in the \"cocktail\" group exhibited significantly higher postoperative recovery scale scores compared to those in the control group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBladder instillation of the \"cocktail\" can prevent catheter-related bladder irritation and improve postoperative recovery in gynecologic patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial was a retrospective registration with the Chinese Clinical Trial Registry (No. ChiCTR2300078550), registered on December 12, 2023.\u003c/p\u003e","manuscriptTitle":"Bladder instillation cocktail for preventing catheter-related bladder irritation after gynecologic surgery: a double-blind, randomized, placebo- controlled study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-18 13:51:41","doi":"10.21203/rs.3.rs-5982473/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2662efed-762a-4b70-bb4e-51ceb0b101c6","owner":[],"postedDate":"February 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T14:08:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-18 13:51:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5982473","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5982473","identity":"rs-5982473","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}