Comparison of the effect of acupoint injection and tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial 

Comparison of the effect of acupoint injection and tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial | 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 Comparison of the effect of acupoint injection and tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial Li Guo, Ping Li, Shuying Li, Jianying Song, Qiaoli Wang, Wanli Tian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5735381/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 Postoperative catheter-related bladder discomfort (CRBD) is a common complication of intraoperative urinary catheterization. We conducted this study to compare the effects of acupoint injection and tramadol for the treatment of postoperative CRBD. Methods Ninety patients who underwent elective gynecological surgery with intraoperative urinary catheterization and spontaneously complained of CRBD during recovery in the post-anaesthesia care unit (PACU) were randomized into three groups of 30 each. Group A received acupoint injections (Zusanli (ST 36), Sanyinjiao (SP 6), Zhongji (CV 3), and Guanyuan (CV 4)), Group B received 1.5 mg/kg tramadol, while Group C received normal saline. The severity of CRBD was measured as none, mild, moderate, or severe; or recorded using visual analog scale (VAS) score ranging from 0 (no discomfort) to 10 (most severe discomfort). These measurements were reported at 0 (immediate treatment time), 0.5, 1, 2 and 6 h after treatment. Results The severity of CRBD was reduced in groups A and B compared to that in group C at 0.5, 1 and 2 h after treatment. The VAS score for CRBD was also lower in groups A and B compared to that in group C after treatment. Additionally, Groups A and B had a higher rate of effective therapy than group C at 0.5, 1 and 2 h after treatment. Group A had a higher rate of effective therapy than groups B and C at immediate treatment time. Group B had a higher incidence of nausea compared to Groups A and C; however, there were no differences observed regarding vomiting, dizziness, drowsiness, or headache. Conclusions Acupoint injection was found to be equally effective as tramadol for treating postoperative CRBD following gynecological surgery. Acupoint injection could even take effect at immediate treatment time. Moreover, tramadol increased the incidence of nausea compared with acupoint injection. Trial registration: ChiCTR2400090605. Registered on 9 October 2024. Catheter-related bladder discomfort acupoint injection tramadol Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Intraoperative urinary catheterization frequently results in postoperative catheter related bladder discomfort (CRBD) during recovery from general anesthesia. The clinical presentation of postoperative CRBD may manifest as discomfort in the suprapubic region or similarly to an overactive bladder, with symptoms such as urinary urgency and frequency, with or without urge incontinence [1]. Postoperative CRBD is a distressing complication that can increase postoperative agitation and pain while reducing the quality of recovery. The clinical incidence of CRBD is reported to be as high as to 90%, necessitating urgent clinical intervention [2, 3]. Various strategies, including non-pharmacological and pharmacological methods, have been implemented to manage CRBD. Tramadol is a commonly used centrally acting analgesic that also has inhibitory effects on M1 and M3 muscarinic receptors of the bladder [4]. It has been reported to be highly effective in preventing and treating postoperative CRBD [5-8]. Transcutaneous electrical acupoint stimulation (TEAS) has been reported to prevent the incidence and severity of postoperative CRBD and reduce the occurrence of postoperative urinary retention [9,10]. Acupuncture has also been reported to improve urinary incontinence and overactive bladder [11,12]. Acupoint therapy refers to various treatments within Traditional Chinese Medicine involving acupoints and meridians, such as electroacupuncture, acupoint injection, manual acupuncture, moxibustion, external application, and catgut embedding. We supposed that acupoint injection could be equally effective compared to tramadol for treating postoperative CRBD. This study was designed to compare the efficacy of acupoint injection with tramadol for treating postoperative CRBD. Methods Ethical approval The randomized control study was approved by the Ethics Committee of Medical Research at West China Second Hospital of Sichuan University on 6 September 2024 (Medical Ethics 2024 Ethics Review No. (209)). This study was registered prior to patient enrolment at Chinese Clinical Trial Registry (ChiCTR2400090605). Written informed consent was obtained from all enrolled patients. The study was conducted from October 2024 to December 2024. Study design and participants Ninety patients with ASA class I-II, aged 18-70 years, who underwent elective gynecological surgery with intraoperative urinary catheterization and spontaneously complained of moderate or severe CRBD during recovery in the PACU were included. Exclusion criteria included bladder outflow obstruction, overactive bladder, urinary tract infection, neurogenic bladder, psychiatric disease, chronic analgesic abuse, morbid obesity, and inability to communicate. Study protocol Ninety patients were randomized assigned into three groups using computer-generated randomized numbers. The assignment was concealed in an envelope and opened by a nurse who was blinded to this study. Group A received acupoint injection of normal saline (Zusanli (ST 36), Sanyinjiao (SP 6), Zhongji (CV 3), and Guanyuan (CV 4)), Group B received 1.5 mg/kg tramadol intravenous injection (IV), and Group C received normal saline IV. The injected acupoints were bilateral Zusanli (ST36) and Sanyinjiao (SP6), Zhongji (CV 3) and Guanyuan (CV 4). The location of acupoints was determined using the guidelines provided in “Nomenclature and Location of Meridian Points” (GB/T12346-2021). After standard skin disinfection, a syringe needle filled with normal saline was vertically inserted into the subcutaneous tissue at each acupoint location based on patient's feedback such as numbness, heaviness or sensation of muscle pain known as Deqi. Once no blood return was ensured after insertion into each point separately, 1 mL normal saline solution was injected followed by withdrawing the needle about 0.3-0.5 cm before injecting another 1 mL normal saline solution again according to detailed operation process referred to the national guidelines for acupoint injection published in 2008 [13]. Data collection and outcomes The severity of CRBD measured using a 4-point scale; or recorded using visual analog scale (VAS) score ranging from 0 (no discomfort) to 10 (most severe discomfort) were reported after 0 (immediate treatment time), 0.5, 1, 2 and 6 h after treatment. The severity of CRBD on the 4-point scale was reported as follows: none, patients did not complain of any CRBD symptoms even when asked; mild, symptoms were only complained about in response to questioning; moderate, spontaneous complaints without questioning but without any behavioral response; and severe, spontaneous complaints with accompanying behavioral responses such as intense verbal response, flailing limbs, and even attempts to remove the urinary catheter. If the severity of CRBD was reported as none or mild, it was considered effective therapy. The effective therapy rate (%) = (none+mild) cases / total cases*100%. Adverse effects such as nausea, vomiting, dizziness, headache, and drowsiness were also assessed. Sattistical analysis The sample size was estimated based on previous studies and preliminary experiments with power analysis α = 0.05 and β = 0.1 to detect differences in the proportion of CRBD between three groups within a range of 0.1 to 0.6. Twenty-four patients were needed in each group, considering a dropout rate of 20% , so finally 30 patients were included in each group. The severity of CRBD measured on 4-point scale, effective therapy rate and adverse effects were reported as percentage frequencies. These variables were analyzed using the chi-square test. The severity of CRBD recorded by VAS score was repeated variables and tested by repeated measures within groups and one-way analysis of variance (ANOVA). Demographic data and clinical data were evaluated by ANOVA. Statistical analysis was analyzed by SPSS 20, and P < 0.05 was considered significant. Results Ninety patients were enrolled in this study, with no withdrawals (Fig 1). There were no significant differences in patient characteristics or clinical data among the three groups (Table 1). There was no significant difference in CRBD severity at the first assessment time in the PACU among the three groups. The severity of mild CRBD was higher in group A compared with that in groups B and C at immediate treatment time. The severity of mild CRBD was higher in groups A and B compared to group C at 0.5 and 1h. The severity of moderate CRBD was decreased in group A and B compared to group C at 0.5, 1 and 2 h. The severity of none CRBD was higher in groups A and B than group C at 1 and 2 h (Table 2). The VAS score for CRBD was lower in groups A and B than in group C (Fig. 2). The rate of effective therapy was higher in groups A and B compared with that in group C at 0.5, 1 and 2 h. Group A had a higher effective therapy rate than groups B and C at immediate treatment time and 2 h (Fig. 3). With regard to the adverse effects, group B increased the incidence of nausea compared with groups A and C, while there were no differences in vomiting, dizziness, drowsiness, or headache (Fig. 4). Discussion In this study, we found that acupoint injection was as effective as tramadol for treating CRBD after elective gynecological surgery. Acupoint injection could even take effect at immediate treatment time. Moreover, tramadol increased the incidence of nausea compared with acupoint injection. Acupoint injection, also known as water needle, is a modified acupuncture technique that originated from intramuscular injection in Western medicine and has been increasingly integrated into traditional Chinese medicine. Various agents are commonly used for acupoint injection, including normal saline, vitamins, Chinese herbal extractions, western medications, and bee venom [14]. The action mechanism of acupoint injection is believed to involve the stimulation of acupoints through meridians and the therapeutic activities of the injected agents [15]. It is widely used in China for various indications such as pain relief, postoperative ileus treatment, nausea and vomiting management, and urine retention alleviation [14] In this study, the selected acupoint injection points were Zusanli (ST 36), Sanyinjiao (SP 6), Zhongji (CV 3), and Guanyuan (CV 4). The combination of Guan Yuan, Zhong Ji,and San Yin Jiao acupoints originated from "Niao San Zhen" in "Jin San Zhen" (JIN's Three Acupuncture Needles Therapy). This study found that acupoint injection with normal saline effectively treated CRBD; moreover, it even showed immediate effects. The mechanisms behind the effectiveness of acupoint injection with normal saline can be explained by the "gate control" theory. Injection of normal saline increases local pressure within the acupoint which activates afferent nerve fibers(A-delta and C fibers); subsequently,the nerve channels are blocked by these afferent fibers. It is acknowledged that muscarinic receptors are instrumental in mediating the involuntary contraction of the bladder, with the M2 and M3 subtypes likely being the predominant receptors implicated in CRBD [16]. Tramadol, a commonly administered centrally acting analgesic, exhibits inhibitory effects on the bladder's M1 and M3 muscarinic receptors. Our previously published research indicated that tramadol demonstrated efficacy in the prophylaxis and treatment of CRBD [7,8]. In concordance with prior studies, the current investigation also revealed that tramadol at a dosage of 1.5 mg/kg is efficacious in the treatment of CRBD. The time to onset of tramadol is less than 10 min, with the peak effect occurring approximately 30 min post-administration. Consequently, the effective therapy rate of tramadol in immediate treatment was found to be lower compared to acupoint injection. Moreover, tramadol was associated with a higher incidence of nausea in comparison to acupoint injection. The present study harbors several limitations. Initially, the postoperative occurrence of CRBD was not assessed across all types of surgery, as varying surgical procedures may elicit differing levels of interference. Additionally, a standardized dose of 2 ml of normal saline was administered at each acupoint, and the dose-response relationship for acupoint injection in the context of CRBD treatment was not investigated. Furthermore, the study exclusively involved female patients, which may introduce gender-based biases that could influence therapeutic outcomes. In conclusion, acupoint injection was as effective as tramadol for treating CRBD after elective gynecological surgery. Acupoint injection could even take effect at immediate treatment time. Moreover, tramadol increased the incidence of nausea compared with acupoint injection. Abbreviations CRBD: catheter-related bladder discomfort; PACU: post-anaesthesia care unit; VAS: visual analog scale; TEAS: Transcutaneous electrical acupoint stimulation; ANOVA: one-way analysis of variance. Declarations Acknowledgements Not applicable. Authors’ contributions Li Guo designed the study and drafted/revised the manuscript. Li Guo, Ping Li, Jianying Song, Qiaoli Wang, and Wanli Tian made contributions to the acquisition of clinical study data. Li Guo and Shuying Li made substantial contributions to the analysis and interpretation of the data. Shuying Li designed the study and revised the manuscript. Funding This study was supported by the Zigong Key Research Base of Philosophy and Social Sciences, Health Humanities Research Center (Grant Number: JKRWY24-02). Availability of data and materials The datasets used and analyzed during the study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The study was approved by the Ethics Committee of Medical Research at West China Second Hospital of Sichuan University on 6 September 2024 (Medical Ethics 2024 Ethics Review No. (209)). It was registered prior to patient enrolment at Chinese Clinical Trial Registry (ChiCTR2400090605). Consent for publication Not applicable. Competing interests The authors report no competing interest. References Andersson KE. The pharmacology of lower urinary tract smooth muscles and penile erectile tissues. Pharmacol Rev. 1993;45:253–308. Binhas M, Motamed C, Hawajri N, Yiou R, Martly J. Predictors of catheter related bladder discomfort in the postanaesthesia care unit. Ann Fr Anesth Reanim. 2011;30(2):122–5. Bai Y, Wang X, Li X, et al. Management of catheter-related bladder discomfort in patients who underwent elective surgery. J Endourol. 2015;29(6):640–9. Bravo L, Mico JA, Berrocoso E. Discovery and development of tramadol for the treatment of pain. Expert Opin Drug Discov. 2017;12:1281–91. Burimsittichai R, Limraksasin P, Hurst CP, Charuluxananan S. Comparison of intravenous tramadol and ketamine for prevention of catheter-related bladder discomfort after laparoscopic surgery: a randomized, placebo-controlled, double-blind study. Nephron Clin Pract. 2017;10(3):253–60. Manandhar S, Manandhar K. Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery. J Patan Acad Health Sci. 2019;6(2):45–50. Li S, Song L, Ma Y, et al. Tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial[J]. BMC Anesthesiol. 2018;18(1):194. Liao X, Xie M, Li S, Yu X. Comparison of tramadol and lornoxicam for the prevention of postoperative catheter-related bladder discomfort: a randomized controlled trial. Perioper Med (Lond). 2023;19(1):27. Liang D, Jin S, Huang L, et al. The Effect of Transcutaneous Electrical Acupoint Stimulation on Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Transurethral Resection of the Prostate. Evid Based Complement Alternat Med. 2021;2021:6691459. Zhang Y, Gong L, Zhang Y, et al. Effect of Transcutaneous Acupoint Electrical Stimulation on Urinary Retention and Urinary ATP in Elderly Patients After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Trial. Clin Interv Aging. 2022;17:1751–60. Chan YT, Zhang HW, Guo YQ, et al. Effectiveness and safety of acupuncture for elderly overactive bladder population in Hong Kong: study protocol for a randomized controlled trial. Trials. 2018;19(1):376. Sun J, Zhang X, Cao T, Song Y. Treatment of urinary incontinence after total hysterectomy with acupuncture: A case report. Med (Baltim). 2019;98(20):e15687. General administration of. quality supervision, inspection and quarantine of the People’s Republic of China, Standardization Administration of the People’s Republic of China. Standardized manipulations of acupuncture and moxibustion-Part 6: Point injection. Beijing: Standards Press of China; 2008. Sha T, Gao LL, Zhang CH, Zheng JG, Meng ZH. An update on acupuncture point injection. QJM. 2016;109(10):639–41. Chen CY, Lin CN, Chern RS, Tsai YC, Chang YH, Chien CH. Neuronal activity stimulated by liquid substrates injection at Zusanli (ST36) acupoint: the possible mechanism of aquapuncture. Evid Based Complement Alternat Med 2014:627342. Igawa Y. Discussion: functional role of M (1), M (2), and M (3) muscarinic receptors in overactive bladder. Urology. 2000;85(S3):47 – 9. Tables Table 1 Patients characteristics and clinical data. Group A Group B Group C Number of patients (n) 30 30 30 Age (year) 49.9 ± 14.7 50.8 ± 9.9 52.1 ± 12.1 Height (cm) 158.5 ± 4.9 156.7 ± 5.4 156.1 ± 5.6 Weight (kg) 59.7 ± 9.3 57.5 ± 8.8 56.8 ± 8.3 Duration of surgery (min) 140.9 ± 62.4 150.5 ± 55.2 148.5 ± 62.0 Anaesthesia duration time (min) 159.8 ± 63.5 164.9 ± 54.4 162.2 ± 59.6 Sufentanil dosage (µg) 23.1 ± 7.1 26.3 ± 6.5 25.7 ± 5.4 Urine output (ml) 318.3 ± 304.1 215.0 ± 134.0 238.3 ± 156.8 Table 2 Incidence and severity of CRBD presented as numbers (n) Time T0 T1 T2 T3 T4 T5 Group A B C A B C A B C A B C A B C A B C Severity No 5 0 0 6 8 0 ** 9 13 *** 3 ** 24 24 21 Mild 6 * 1 0 8 10 0 ** 15 10 *** 4 ** 17 8 13 5 5 9 Moderate 24 27 28 23 26 28 17 20 30 ** 9 12 26 ** 4 9 *** 14 ** 1 1 0 Severe 6 3 2 1 3 2 *P < 0.05 for comparison between group A vs group C. **P < 0.05 for comparison between group C vs groups A and B. ***P < 0.05 for comparison between group A vs group B. T0: 0 h, T1: immediate treatment time,T2: 0.5 h, T3: 1 h, T4: 2 h, T5: 6 h after treatment. 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-5735381","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":396180146,"identity":"2100e8ff-ae35-4375-a3f6-7eb399a872cd","order_by":0,"name":"Li Guo","email":"","orcid":"","institution":"West China Second Hospital of Sichuan University, sichuan University, Ministry of education","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Guo","suffix":""},{"id":396180147,"identity":"a134e5db-be88-429e-8035-dfed0c4bdc8c","order_by":1,"name":"Ping Li","email":"","orcid":"","institution":"West China Second 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09:06:34","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14402,"visible":true,"origin":"","legend":"\u003cp\u003eThe VAS score of CRBD among the three groups.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5735381/v1/6b03f6026efe1e80f56bfbb7.jpg"},{"id":72796653,"identity":"7a146b1c-c507-442e-8567-1db4e2755664","added_by":"auto","created_at":"2025-01-02 09:06:34","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16751,"visible":true,"origin":"","legend":"\u003cp\u003eThe effective therapy rate of CRBD among the three groups.\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5735381/v1/91be8a1cd27dcd9c367dace4.jpg"},{"id":72796659,"identity":"acfab250-5a70-4ece-bff3-7d7e3f9a73ea","added_by":"auto","created_at":"2025-01-02 09:06:34","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":15333,"visible":true,"origin":"","legend":"\u003cp\u003eThe adverse effects among the three groups.\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5735381/v1/aff616599ff914d2dcc2bda5.jpg"},{"id":79752007,"identity":"455d9977-579b-481a-a815-a689699a4b54","added_by":"auto","created_at":"2025-04-02 09:32:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":653006,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5735381/v1/0f557142-e12f-470e-b34e-d99d2c843fd9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of the effect of acupoint injection and tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial ","fulltext":[{"header":"Background","content":"\u003cp\u003eIntraoperative urinary catheterization frequently results in postoperative catheter related bladder discomfort (CRBD) during recovery\u0026nbsp;from general anesthesia. The clinical presentation of postoperative CRBD may manifest as discomfort in the suprapubic region or similarly to an overactive bladder, with symptoms such as urinary urgency and frequency, with or without urge incontinence [1]. Postoperative CRBD is a distressing complication that can increase postoperative agitation and pain while reducing the quality of recovery. The clinical incidence of CRBD is reported to be as high as to 90%, necessitating urgent clinical intervention [2, 3].\u003c/p\u003e\n\u003cp\u003eVarious strategies, including non-pharmacological and pharmacological methods, have been implemented to manage CRBD. Tramadol is a\u0026nbsp;commonly used centrally acting analgesic that also has inhibitory effects on M1 and M3 muscarinic receptors of the bladder [4]. It has been reported to be highly\u0026nbsp;effective in preventing and treating postoperative CRBD [5-8]. Transcutaneous electrical acupoint stimulation (TEAS) has been reported to prevent the incidence and severity of postoperative CRBD and reduce the occurrence of postoperative urinary retention [9,10]. Acupuncture has also been reported to improve urinary incontinence and overactive bladder [11,12]. Acupoint therapy refers to various treatments within Traditional Chinese Medicine involving acupoints and meridians, such as electroacupuncture, acupoint injection, manual acupuncture, moxibustion, external application, and catgut embedding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe supposed that acupoint injection could be equally effective compared to tramadol for treating postoperative CRBD. This study was designed to compare the efficacy of acupoint injection with tramadol for treating postoperative CRBD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe randomized control study was approved by the Ethics Committee of Medical Research at West China Second Hospital of Sichuan University on 6 September 2024 (Medical Ethics 2024 Ethics Review No. (209)). This study was registered prior to patient enrolment at Chinese Clinical Trial Registry (ChiCTR2400090605).\u0026nbsp;Written informed consent was obtained from all enrolled patients.\u0026nbsp;The study was conducted from October 2024 to December 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNinety patients with ASA class I-II, aged 18-70 years, who underwent elective gynecological surgery\u0026nbsp;with intraoperative urinary catheterization\u0026nbsp;and spontaneously complained of moderate or severe CRBD\u0026nbsp;during recovery\u0026nbsp;in the PACU were included. Exclusion criteria included bladder outflow obstruction, overactive bladder, urinary tract infection, neurogenic bladder, psychiatric disease, chronic analgesic abuse, morbid obesity, and inability to communicate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNinety patients were randomized assigned into three groups using computer-generated randomized numbers. The assignment was concealed in an envelope and opened by a nurse who was blinded to this study. Group A received acupoint injection of normal saline (Zusanli (ST 36), Sanyinjiao (SP 6), Zhongji (CV 3), and Guanyuan (CV 4)), Group B received 1.5 mg/kg tramadol intravenous injection (IV), and Group C received normal saline IV. The injected acupoints were bilateral Zusanli (ST36) and Sanyinjiao (SP6), Zhongji (CV 3) and Guanyuan (CV 4). The location of acupoints was determined using the guidelines provided in \u0026ldquo;Nomenclature and Location of Meridian Points\u0026rdquo; (GB/T12346-2021). After standard skin disinfection, a syringe needle filled with normal saline was vertically inserted into the subcutaneous tissue at each acupoint location based on patient\u0026apos;s feedback such as numbness, heaviness or sensation of muscle pain known as Deqi. Once no blood return was ensured after insertion into each point separately, 1 mL normal saline solution was injected followed by withdrawing the needle about 0.3-0.5 cm before injecting another 1 mL normal saline solution again according to detailed operation process referred to the\u0026nbsp;national guidelines for acupoint injection published in 2008 [13].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe severity of CRBD measured\u0026nbsp;using a 4-point scale; or\u0026nbsp;recorded using\u0026nbsp;visual analog scale (VAS)\u0026nbsp;score ranging from 0 (no discomfort) to 10 (most severe discomfort)\u0026nbsp;were\u0026nbsp;reported\u0026nbsp;after 0\u0026nbsp;(immediate treatment time),\u0026nbsp;0.5, 1, 2 and 6 h after treatment.\u0026nbsp;The severity of CRBD on the 4-point scale was reported as follows: none, patients did not complain of any CRBD symptoms even when asked; mild, symptoms were only complained about in response to questioning; moderate, spontaneous complaints without questioning but without any behavioral response; and severe, spontaneous complaints with accompanying behavioral responses such as intense verbal response, flailing limbs, and even attempts to remove the urinary catheter. If the severity of CRBD was reported as none or mild, it was considered effective therapy. The effective therapy rate (%) = (none+mild) cases / total cases*100%. Adverse effects such as nausea, vomiting, dizziness, headache, and drowsiness were also assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSattistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was estimated based on previous studies and preliminary experiments with power analysis \u0026alpha; = 0.05 and \u0026beta; = 0.1 to detect differences in the proportion of CRBD between three groups within a range of 0.1 to 0.6. Twenty-four patients were needed in each group, considering a dropout rate of 20% , so finally 30 patients were included in each group. The severity of CRBD measured on 4-point scale, effective therapy rate and adverse effects were reported as percentage frequencies. These variables were analyzed using the chi-square test. The severity of CRBD recorded by VAS score was repeated variables and tested by repeated measures within groups and one-way analysis of variance (ANOVA). Demographic data and clinical data were evaluated by ANOVA. Statistical analysis was analyzed by SPSS 20, and P \u0026lt; 0.05 was considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eNinety patients were enrolled in this study, with no withdrawals (Fig 1). There were no significant differences in patient characteristics or\u0026nbsp;clinical data\u0026nbsp;among the three groups (Table 1).\u003c/p\u003e\n\u003cp\u003eThere was no significant difference in CRBD severity at the first assessment time in the PACU among the three groups. The severity of mild CRBD was higher in group A compared with that in groups B and C at immediate treatment time. The severity of mild CRBD was higher in groups A and B compared to group C at 0.5 and 1h. The severity of moderate CRBD was decreased in group A and B compared to group C at 0.5, 1 and 2 h. The severity of none CRBD was higher in groups A and B than group C at 1 and 2 h (Table 2). The VAS score for CRBD was lower in groups A and B than in group C (Fig. 2). The rate of effective therapy was higher in groups A and B compared with that in group C at 0.5, 1 and 2 h. Group A had a higher effective therapy rate than groups B and C at immediate treatment time and 2 h (Fig. 3). With regard to the adverse effects, group B increased the incidence of nausea compared with groups A and C, while there were no differences in vomiting, dizziness, drowsiness, or headache (Fig. 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we found that\u0026nbsp;acupoint injection\u0026nbsp;was as effective as tramadol for treating CRBD after\u0026nbsp;elective gynecological surgery. Acupoint injection could\u0026nbsp;even take effect at\u0026nbsp;immediate treatment time.\u0026nbsp;Moreover, tramadol increased the incidence of nausea compared with acupoint injection.\u003c/p\u003e\n\u003cp\u003eAcupoint injection, also known as water needle, is a modified acupuncture technique that originated from intramuscular injection in Western medicine and has been increasingly integrated into traditional Chinese medicine. Various agents are commonly used for acupoint injection, including normal saline, vitamins, Chinese herbal extractions, western medications, and bee venom [14]. The action mechanism of acupoint injection is believed to involve the stimulation of acupoints through meridians and the therapeutic activities of the injected agents [15]. It is widely used in China for various indications such as pain relief, postoperative ileus treatment, nausea and vomiting management, and urine retention alleviation [14]\u003c/p\u003e\n\u003cp\u003eIn this study, the selected acupoint injection points were Zusanli (ST 36), Sanyinjiao (SP 6), Zhongji (CV 3), and Guanyuan (CV 4). The combination of Guan Yuan, Zhong Ji,and San Yin Jiao acupoints originated from \u0026quot;Niao San Zhen\u0026quot; in \u0026quot;Jin San Zhen\u0026quot; (JIN\u0026apos;s Three Acupuncture Needles Therapy). This study found that acupoint injection with normal saline effectively treated CRBD; moreover, it even showed immediate effects. The mechanisms behind the effectiveness of acupoint injection with normal saline can be explained by the \u0026quot;gate control\u0026quot; theory. Injection of normal saline increases local pressure within the acupoint which activates afferent nerve fibers(A-delta and C fibers); subsequently,the nerve channels are blocked by these afferent fibers.\u003c/p\u003e\n\u003cp\u003eIt is acknowledged that muscarinic receptors are instrumental in mediating the involuntary contraction of the bladder, with the M2 and M3 subtypes likely being the predominant receptors implicated in CRBD [16]. Tramadol, a commonly administered centrally acting analgesic, exhibits inhibitory effects on the bladder\u0026apos;s M1 and M3 muscarinic receptors. Our previously published research indicated that tramadol demonstrated efficacy in the prophylaxis and treatment of CRBD [7,8]. In concordance with prior studies, the current investigation also revealed that tramadol at a dosage of 1.5 mg/kg is efficacious in the treatment of CRBD. The time to onset of tramadol is less than 10 min, with the peak effect occurring approximately 30 min post-administration. Consequently, the effective\u0026nbsp;therapy\u0026nbsp;rate\u0026nbsp;of tramadol in immediate treatment was found to be lower compared to acupoint injection. Moreover, tramadol was associated with a higher incidence of nausea in comparison to acupoint injection.\u003c/p\u003e\n\u003cp\u003eThe present study harbors several limitations. Initially, the postoperative occurrence of CRBD was not assessed across all types of surgery, as varying surgical procedures may elicit differing levels of interference. Additionally, a standardized dose of 2 ml of normal saline was administered at each acupoint, and the dose-response relationship for acupoint injection in the context of CRBD treatment was not investigated. Furthermore, the study exclusively involved female patients, which may introduce gender-based biases that could influence therapeutic outcomes.\u003c/p\u003e\n\u003cp\u003eIn conclusion, acupoint injection was as effective as tramadol for treating CRBD after elective gynecological surgery. Acupoint injection could even take effect at immediate treatment time. Moreover, tramadol increased the incidence of nausea compared with acupoint injection.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCRBD: catheter-related bladder discomfort; PACU: post-anaesthesia care unit; VAS: visual analog scale; TEAS: Transcutaneous electrical acupoint stimulation; ANOVA: one-way analysis of variance.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi Guo designed the study and drafted/revised the manuscript. Li Guo, Ping Li, Jianying Song, Qiaoli Wang, and Wanli Tian made contributions to the acquisition of clinical study data. Li Guo and Shuying Li made substantial contributions to the analysis and interpretation of the data. Shuying Li designed the study and revised the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Zigong Key Research Base of Philosophy and Social Sciences, Health Humanities Research Center (Grant Number: JKRWY24-02).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Medical Research at West China Second Hospital of Sichuan University on 6 September 2024 (Medical Ethics 2024 Ethics Review No. (209)). It was registered prior to patient enrolment at Chinese Clinical Trial Registry (ChiCTR2400090605).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAndersson KE. The pharmacology of lower urinary tract smooth muscles and penile erectile tissues. Pharmacol Rev. 1993;45:253\u0026ndash;308.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBinhas M, Motamed C, Hawajri N, Yiou R, Martly J. Predictors of catheter related bladder discomfort in the postanaesthesia care unit. Ann Fr Anesth Reanim. 2011;30(2):122\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai Y, Wang X, Li X, et al. Management of catheter-related bladder discomfort in patients who underwent elective surgery. J Endourol. 2015;29(6):640\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBravo L, Mico JA, Berrocoso E. Discovery and development of tramadol for the treatment of pain. Expert Opin Drug Discov. 2017;12:1281\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurimsittichai R, Limraksasin P, Hurst CP, Charuluxananan S. Comparison of intravenous tramadol and ketamine for prevention of catheter-related bladder discomfort after laparoscopic surgery: a randomized, placebo-controlled, double-blind study. Nephron Clin Pract. 2017;10(3):253\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManandhar S, Manandhar K. Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery. J Patan Acad Health Sci. 2019;6(2):45\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Song L, Ma Y, et al. Tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial[J]. BMC Anesthesiol. 2018;18(1):194.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao X, Xie M, Li S, Yu X. Comparison of tramadol and lornoxicam for the prevention of postoperative catheter-related bladder discomfort: a randomized controlled trial. Perioper Med (Lond). 2023;19(1):27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang D, Jin S, Huang L, et al. The Effect of Transcutaneous Electrical Acupoint Stimulation on Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Transurethral Resection of the Prostate. Evid Based Complement Alternat Med. 2021;2021:6691459.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Gong L, Zhang Y, et al. Effect of Transcutaneous Acupoint Electrical Stimulation on Urinary Retention and Urinary ATP in Elderly Patients After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Trial. Clin Interv Aging. 2022;17:1751\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan YT, Zhang HW, Guo YQ, et al. Effectiveness and safety of acupuncture for elderly overactive bladder population in Hong Kong: study protocol for a randomized controlled trial. Trials. 2018;19(1):376.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun J, Zhang X, Cao T, Song Y. Treatment of urinary incontinence after total hysterectomy with acupuncture: A case report. Med (Baltim). 2019;98(20):e15687.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeneral administration of. quality supervision, inspection and quarantine of the People\u0026rsquo;s Republic of China, Standardization Administration of the People\u0026rsquo;s Republic of China. Standardized manipulations of acupuncture and moxibustion-Part 6: Point injection. Beijing: Standards Press of China; 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSha T, Gao LL, Zhang CH, Zheng JG, Meng ZH. An update on acupuncture point injection. QJM. 2016;109(10):639\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen CY, Lin CN, Chern RS, Tsai YC, Chang YH, Chien CH. Neuronal activity stimulated by liquid substrates injection at Zusanli (ST36) acupoint: the possible mechanism of aquapuncture. Evid Based Complement Alternat Med 2014:627342.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIgawa Y. Discussion: functional role of M (1), M (2), and M (3) muscarinic receptors in overactive bladder. Urology. 2000;85(S3):47\u0026thinsp;\u0026ndash;\u0026thinsp;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003ePatients characteristics and clinical data.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eGroup A\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eGroup B\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eGroup C\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNumber of patients (n)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge (year)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e50.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e52.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHeight (cm)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e158.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e156.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e156.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eWeight (kg)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e59.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e57.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e56.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDuration of surgery (min)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e140.9\u0026thinsp;\u0026plusmn;\u0026thinsp;62.4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e150.5\u0026thinsp;\u0026plusmn;\u0026thinsp;55.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e148.5\u0026thinsp;\u0026plusmn;\u0026thinsp;62.0\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAnaesthesia duration time (min)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e159.8\u0026thinsp;\u0026plusmn;\u0026thinsp;63.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e164.9\u0026thinsp;\u0026plusmn;\u0026thinsp;54.4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e162.2\u0026thinsp;\u0026plusmn;\u0026thinsp;59.6\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSufentanil dosage (\u0026micro;g)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e25.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUrine output (ml)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e318.3\u0026thinsp;\u0026plusmn;\u0026thinsp;304.1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e215.0\u0026thinsp;\u0026plusmn;\u0026thinsp;134.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e238.3\u0026thinsp;\u0026plusmn;\u0026thinsp;156.8\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidence and severity of CRBD presented as numbers (n)\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"19\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTime\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eT0\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eT1\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003eT2\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cdiv class=\"SimplePara\"\u003eT3\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cdiv class=\"SimplePara\"\u003eT4\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c18\"\u003e \u003cdiv class=\"SimplePara\"\u003eT5\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGroup\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eC\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eC\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003eC\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cdiv class=\"SimplePara\"\u003eC\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cdiv class=\"SimplePara\"\u003eC\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cdiv class=\"SimplePara\"\u003eA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cdiv class=\"SimplePara\"\u003eB\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cdiv class=\"SimplePara\"\u003eC\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSeverity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003csup\u003e**\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cdiv class=\"SimplePara\"\u003e13\u003csup\u003e***\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003csup\u003e**\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMild\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e6\u003csup\u003e*\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003csup\u003e**\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cdiv class=\"SimplePara\"\u003e10\u003csup\u003e***\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u003csup\u003e**\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cdiv class=\"SimplePara\"\u003e17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cdiv class=\"SimplePara\"\u003e13\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eModerate\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e23\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e20\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003csup\u003e**\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u003csup\u003e**\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003csup\u003e***\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003csup\u003e**\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSevere\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"19\"\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for comparison between group A vs group C. **P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for comparison between group C vs groups A and B. ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for comparison between group A vs group B. T0: 0 h, T1: immediate treatment time,T2: 0.5 h, T3: 1 h, T4: 2 h, T5: 6 h after treatment.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\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":"Catheter-related bladder discomfort, acupoint injection, tramadol","lastPublishedDoi":"10.21203/rs.3.rs-5735381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5735381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative catheter-related bladder discomfort (CRBD) is a common complication of intraoperative urinary catheterization. We conducted this study to compare the effects of acupoint injection and tramadol for the treatment of postoperative CRBD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eNinety patients who underwent elective gynecological surgery with intraoperative urinary catheterization and spontaneously complained of CRBD during recovery in the post-anaesthesia care unit (PACU) were randomized into three groups of 30 each. Group A received acupoint injections (Zusanli (ST 36), Sanyinjiao (SP 6), Zhongji (CV 3), and Guanyuan (CV 4)), Group B received 1.5 mg/kg tramadol, while Group C received normal saline. The severity of CRBD was measured as none, mild, moderate, or severe; or recorded using visual analog scale (VAS) score ranging from 0 (no discomfort) to 10 (most severe discomfort). These measurements were reported at 0 (immediate treatment time), 0.5, 1, 2 and 6 h after treatment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe severity of CRBD was reduced in groups A and B compared to that in group C at 0.5, 1 and 2 h after treatment. The VAS score for CRBD was also lower in groups A and B compared to that in group C after treatment. Additionally, Groups A and B had a higher rate of effective therapy than group C at 0.5, 1 and 2 h after treatment. Group A had a higher rate of effective therapy than groups B and C at immediate treatment time. Group B had a higher incidence of nausea compared to Groups A and C; however, there were no differences observed regarding vomiting, dizziness, drowsiness, or headache.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAcupoint injection was found to be equally effective as tramadol for treating postoperative CRBD following gynecological surgery. Acupoint injection could even take effect at immediate treatment time. Moreover, tramadol increased the incidence of nausea compared with acupoint injection.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eChiCTR2400090605. Registered on 9 October 2024.\u003c/p\u003e","manuscriptTitle":"Comparison of the effect of acupoint injection and tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-02 09:06:29","doi":"10.21203/rs.3.rs-5735381/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":"765463fc-b10e-4803-895a-4992bde34ffa","owner":[],"postedDate":"January 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-02T09:23:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-02 09:06:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5735381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5735381","identity":"rs-5735381","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}