Clinical Scorecard: Effectiveness and Safety of an Enhanced Xiao-Xu-Ming-Tang Hot Compress in Alleviating Catheter-Related Bladder Discomfort: A Multicenter, Randomized, Double-Blind, Controlled Study

At a Glance

Key Highlights

• CRBD occurs in 47–95% of patients recovering from general anesthesia with indwelling catheters and increases risk of postoperative delirium.
• Improved Xiao-Xu-Ming-Tang hot compress (40–45 °C) applied suprapubically immediately after intubation reduces incidence and severity of CRBD.
• The herbal components have good transdermal permeability, act locally without systemic absorption, and provide a cost-effective, simple intervention.

Guideline-Based Recommendations

Diagnosis

• Identify CRBD by symptoms of frequent and urgent urination and suprapubic burning sensation in patients with indwelling catheters post-anesthesia.

Management

• Apply improved Xiao-Xu-Ming-Tang hot compress (40–45 °C) above the pubic symphysis immediately after intubation to prevent moderate-to-severe CRBD.
• Consider traditional methods such as local anesthesia, nerve blocks, or pharmacologic agents (lidocaine, bupivacaine, magnesium sulfate, nefopam) as adjuncts.
• Use TCM hot compresses as a cost-effective, non-invasive alternative to reduce CRBD symptoms.

Monitoring & Follow-up

• Monitor incidence and severity of CRBD using standardized scales (e.g., Numerical Rating Scale for pain) postoperatively.
• Observe for skin discomfort or adverse reactions at hot compress application site.
• Monitor vital signs including blood pressure, heart rate, and oxygen saturation during and after intervention.

Risks

• Minimal systemic side effects due to local transdermal action of herbal components.
• Potential for mild skin discomfort at application site.

Patient & Prescribing Data

Ninety patients undergoing transurethral ureteral laser lithotripsy with postoperative indwelling catheters

Hot compress with improved Xiao-Xu-Ming-Tang powder mixed with salt at 40–45 °C applied suprapubically immediately after intubation effectively reduces moderate-to-severe CRBD incidence and improves patient satisfaction without systemic adverse effects.

Clinical Best Practices

• Apply the hot compress immediately after intubation to maximize preventive effect on CRBD.
• Maintain compress temperature between 40–45 °C to optimize skin permeability and patient comfort.
• Use the improved Xiao-Xu-Ming-Tang formula with specified herbal components for targeted anti-spasm and analgesic effects.
• Monitor patients closely for skin reactions and vital signs during treatment.
• Incorporate TCM hot compress as part of multimodal CRBD management to reduce reliance on pharmacologic interventions.

References

• Clinical trial registration ITMCTR2025000321