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Electroacupuncture for bladder function recovery in patients undergoing spinal anesthesia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:892619. [PMID: 25610486 PMCID: PMC4290146 DOI: 10.1155/2014/892619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/10/2014] [Indexed: 02/07/2023]
Abstract
Purpose. To determine the efficacy of electroacupuncture on recovering postanesthetic bladder function. Materials and Methods. Sixty-one patients undergoing spinal anaesthesia were recruited and allocated into electroacupuncture or control group randomly. Patients in electroacupuncture group received electroacupuncture therapy whereas ones in control group were not given any intervention. Primary endpoint was incidence of bladder overdistension and postoperative urinary retention. Secondary endpoints included time to spontaneous micturition, voided volume, and adverse events. Results. All patients (31 in electroacupuncture group and 30 in control group) completed the evaluation. During postoperative follow-up, patients in electroacupuncture group presented a significant lower proportion of bladder overdistension than counterparts in control group (16.1% versus 53.3%, P < 0.01). However, no significant difference was found in incidence of postoperative urinary retention between the two groups (0% versus 6.7%, P > 0.05). Furthermore, a shorter time to spontaneous micturition was found in electroacupuncture group compared to control group (228 min versus 313 min, P < 0.001), whereas urine volume and adverse events had no significant difference between the two groups. Conclusions. Electroacupuncture reduced the proportion of bladder overdistension and shortened the time to spontaneous micturition in patients undergoing spinal anesthesia. Electroacupuncture may be a therapeutic strategy for postanesthetic bladder dysfunction.
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Prakash S, Kale S, Mullick P, Gogia AR. Cardiovascular manifestations of perioperative acute urinary bladder over-distension. Indian J Anaesth 2014; 58:502-4. [PMID: 25197139 PMCID: PMC4155316 DOI: 10.4103/0019-5049.139033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Smita Prakash
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Suniti Kale
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Parul Mullick
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anoop R Gogia
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Adunsky A, Nenaydenko O, Koren-Morag N, Puritz L, Fleissig Y, Arad M. Perioperative urinary retention, short-term functional outcome and mortality rates of elderly hip fracture patients. Geriatr Gerontol Int 2014; 15:65-71. [PMID: 24418251 DOI: 10.1111/ggi.12229] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/26/2022]
Abstract
AIM Perioperative urinary retention (POUR) is common among hip fracture patients. The aim of the present study was to compare the prevalence, risk factors, functional outcomes and survival rates of patients with and without POUR. METHODS This was a retrospective chart review study that was carried out in an orthogeriatric hip fracture unit. A total of 639 consecutive hip fracture patients who had hip surgery followed by a standard rehabilitation course participated in the study. Post-void residual volume (PVRV), Functional Independence Measure (FIM) scores (total and motor FIM, FIM gain) and mortality rates (90 and 365 days, end of follow up) were measured. RESULTS A total of 328 patients (51.3%) suffered from POUR. Diabetes (OR 1.55, 95% CI 1.04-2.31), urinary infection (OR 3.25, 95% CI 2.16-4.90) and delirium (OR 1.66. 95% CI 1.09-2.52) emerged as the best predictors for POUR. Functional gains were slightly better in patients without POUR (P = 0.037 and P = 0.023, for discharge motor and total FIM gain, respectively). There were no differences in FIM gains at discharge in male patients, whether with or without POUR. However, female patients without POUR showed significantly better motor and total FIM gains on discharge (P = 0.003 and P = 0.003, respectively), compared with females with POUR. In multiple linear regression analyses, POUR in female (but not male) patients was predictive for adverse motor FIM gain (beta = -0.089, P = 0.046). In Cox regression analysis, urinary retention was not associated with mortality rates. CONCLUSIONS POUR is highly prevalent in elderly hip fracture patients. It adversely affects the functional outcome of female patients, but is not associated with increased mortality rates.
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Affiliation(s)
- Abraham Adunsky
- Department of Geriatric Medicine and Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel; The Orthogeriatric Hip Fracture Unit, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel
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Nesbitt-Hawes EM, Zhang CS, Won HR, Law K, Abbott JA. Urinary retention following laparoscopic gynaecological surgery with or without 4% icodextrin anti-adhesion solution. Aust N Z J Obstet Gynaecol 2013; 53:305-9. [PMID: 23731096 DOI: 10.1111/ajo.12073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/06/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urinary retention is a recognised complication of laparoscopic surgery. Previous work showed an association with 4% icodextrin solution and urinary retention. AIMS To determine the incidence of urinary retention following laparoscopic gynaecological surgery with or without the use of 4% icodextrin. METHODS A prospective observational study of 147 women undergoing laparoscopic gynaecological surgery for benign pathology. Women had their planned laparoscopic procedure and either received icodextrin solution or nothing as determined by their treating surgeon at the time of the operation. RESULTS From May 2011 to February 2012, 147 women were approached to participate in the study; of whom, 124 women were included: 62 received icodextrin and 62 did not. The women in the non-icodextrin group were significantly older (P = 0.007) and had a higher BMI (P = 0.03) than those in the icodextrin group. Following surgery, 27/124 (21.8%) women had post-operative urinary retention. Icodextrin was associated with significantly more urinary retention (P = 0.017), but did not extend hospital admission significantly (P = 0.14). The administration of icodextrin was associated with resection of moderate- or severe-stage endometriosis involving multiple surgical sites, whereas women in the non-icodextrin group were more likely to be having a hysterectomy. CONCLUSIONS In this non-randomised study, there were significantly more women with post-operative urinary retention when icodextrin was used; however, this did not contribute to an extended hospital admission. While there may be confounding factors, women receiving icodextrin should be warned of the possibility of urinary retention post-operatively, but that this is unlikely to affect their stay in hospital.
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Tobu S, Noguchi M, Hashikawa T, Uozumi J. Risk factors of postoperative urinary retention after hip surgery for femoral neck fracture in elderly women. Geriatr Gerontol Int 2013; 14:636-9. [PMID: 24215579 DOI: 10.1111/ggi.12150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
AIM The aim of the present study was to evaluate risk factors for postoperative urinary retention (POUR) in female patients with femoral neck fractures. METHODS We recruited 72 female patients (age 86.5 ± 6.7 years) from among 90 cases of hip surgery carried out between January and December 2011 at Goto Chuo Hospital. We evaluated the risk factors for POUR, including the administration of anticholinergic drugs, diabetes mellitus, preoperative dementia and/or delirium, neurological disorders, age, hypertension, overactive bladder, and the postoperative duration of the use of an indwelling urethral catheter using a multiple logistic regression analysis. RESULTS In the present study, POUR occurred in eight out of 72 cases (11.1%). The multivariate analysis showed that the indwelling period of the urethral catheter (per 1-day increase; P = 0.04, OR 0.33 95% CI 0.11-0.96), and preoperative dementia and/or delirium (P = 0.03, OR10.4, 95%CI 1.21-89.2) correlated with the occurrence of POUR. Diabetes mellitus (P = 0.78), anticholinergic agents (P = 0.23), neurological disorders (P = 0.83), age (P = 0.86), hypertension (P = 0.76) and overactive bladder (P = 0.34) did not significantly correlate with the occurrence of POUR. CONCLUSIONS The present study showed that the early removal of the urethral catheter, and preoperative dementia and/or delirium had significant correlations with POUR. The femoral neck fractures and the surgical procedure used for the hip surgery do not induce damage to the bladder and nerve system related to the voiding function, and the voiding function in all of the patients recovered after short-term intermittent catheterization. Physicians should not place permanent indwelling urethral catheters without carrying out urological assessments.
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Affiliation(s)
- Shohei Tobu
- Department of Urology, Saga University Faculty of Medicine, Saga, Japan
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Lapitan MCM, Buckley BS, Lascano R, Abalajon MJ. Drugs for the prevention of postoperative urinary retention in adults. Hippokratia 2013. [DOI: 10.1002/14651858.cd010759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Marie Carmela M Lapitan
- National Institutes of Health Manila, University of the Philippines Manila; Division of Urology; Taft Ave Manila Philippines 1000
| | - Brian S Buckley
- University of Phillipines; Department of Surgery; Manila Philippines
| | - Roy Lascano
- University of Phillipines; Department of Surgery; Manila Philippines
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McLeod L, Southerland K, Bond J. A Clinical Audit of Postoperative Urinary Retention in the Postanesthesia Care Unit. J Perianesth Nurs 2013; 28:210-6. [DOI: 10.1016/j.jopan.2012.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 08/13/2012] [Accepted: 10/08/2012] [Indexed: 10/26/2022]
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Hälleberg Nyman M, Gustafsson M, Langius-Eklöf A, Johansson JE, Norlin R, Hagberg L. Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis. Int J Nurs Stud 2013; 50:1589-98. [PMID: 23768410 DOI: 10.1016/j.ijnurstu.2013.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 04/26/2013] [Accepted: 05/13/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery. OBJECTIVES The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness. DESIGN Randomised controlled trial with cost-effectiveness analysis. SETTING The study was carried out at an orthopaedic department at a Swedish University Hospital. METHODS One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge. RESULTS Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI -6.9-11.6%) The patients in the intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans (p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods. CONCLUSIONS Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.
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Affiliation(s)
- Maria Hälleberg Nyman
- Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
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Abstract
BACKGROUND National quality initiatives have mandated the earlier removal of urinary catheters after surgery to decrease urinary tract infection rates. A potential unintended consequence is an increased postoperative urinary retention rate. OBJECTIVE The aim of this study was to determine the incidence and risk factors for postoperative urinary retention after colorectal surgery. DESIGN This was a prospective observational study. SETTINGS A colorectal unit within a single institution was the setting for this study. PATIENTS Adults undergoing elective colorectal operations were included. INTERVENTIONS Urinary catheters were removed on postoperative day 1 for patients undergoing abdominal operations, and on day 3 for patients undergoing pelvic operations. Postvoid residual and retention volumes were measured. MAIN OUTCOME MEASURES The primary outcomes measured were urinary retention and urinary tract infection. RESULTS The overall urinary retention rate was 22.4% (22.8% in the abdominal group, 21.9% in the pelvic group) and was associated with longer operative time and increased perioperative fluid administration. Mean operative time for those with retention was 2.8 hours and, for those without retention, the mean operative time 2.2 hours (abdominal group 2 hours vs 1.4 hours, pelvic group 3.9 hours vs 3.1 hours, p ≤ 0.02). Patients with retention received a mean of 2.7L during the operation, whereas patients without retention received 1.8L (abdominal group 1.9L vs 1.4L, pelvic group 3.6L vs 2.2L, p < 0.01). In the abdominal group, patients with and without retention also received different fluid volumes on postoperative days 1 (2.2L vs 1.7L, p = 0.004) and 2 (1.6L vs 1L, p = 0.05). Laparoscopic abdominal group had a 40% retention rate in comparison with 12% in the open abdominal group (p = 0.004). Age, sex, preoperative radiation therapy, preoperative prostatism, preoperative diagnosis, and level of anastomosis were not associated with retention. The urinary tract infection rate was 4.9%. LIMITATION The lack of documentation of preoperative urinary function was a limitation of this study. CONCLUSIONS The practice of earlier urinary catheter removal must be balanced with operative time and fluid volume to avoid high urinary retention rates. Also important is increased vigilance for the early detection of retention.
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Iramaneerat C, Yongpradit T. Postoperative urinary retention in benign inguinal and anorectal operations. SURGICAL PRACTICE 2013. [DOI: 10.1111/1744-1633.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Johansson RM, Malmvall BE, Andersson-Gäre B, Larsson B, Erlandsson I, Sund-Levander M, Rensfelt G, Mölstad S, Christensson L. Guidelines for preventing urinary retention and bladder damage during hospital care. J Clin Nurs 2012; 22:347-55. [DOI: 10.1111/j.1365-2702.2012.04229.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Choi S, Mahon P, Awad IT. Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review. Can J Anaesth 2012; 59:681-703. [PMID: 22535232 DOI: 10.1007/s12630-012-9717-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/13/2012] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Urinary retention requiring catheterization carries the risk of infection. Neuraxial anesthesia causes transient impairment of bladder function ranging from delayed initiation of micturition to frank urinary retention. We undertook a review of the literature to determine the elements of neuraxial anesthesia and analgesia that prolong bladder dysfunction and increase the incidence of urinary retention. METHODS We performed a systematic search of the PubMed, MEDLINE, and EMBASE databases (from January 1980 to January 2011) to identify studies where neuraxial anesthesia and/or analgesia were employed and at least one of the following outcomes was reported: urinary retention, time to micturition, or post void residual. We included randomized controlled trials and observational studies published in the English language and we excluded case reports. The randomized trials were graded according to the Jadad score. PRINCIPAL FINDINGS Our search yielded 94 studies, and in 16 of these studies, the authors reported time to micturition after intrathecal anesthesia of varying local anesthetics and doses. Intrathecal injections were performed in 41 of these studies, epidural anesthesia/analgesia was used in 39 studies, and five studies involved both the intrathecal and epidural routes. Meta-analysis was not possible because of the heterogeneity of interventions and reported outcomes. The duration of detrusor dysfunction after intrathecal anesthesia is correlated with local anesthetic dose and potency. The incidence of urinary retention displays a similar trend and is further increased by the presence of neuraxial opioids, particularly long-acting variants. Urinary tract infection secondary to catheterization occurred rarely. CONCLUSIONS Neuraxial anesthesia/analgesia results in transient detrusor dysfunction. The duration of dysfunction depends on the potency and dose of medication used; however, it does not appear to result in significant morbidity.
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Affiliation(s)
- Stephen Choi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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Madersbacher H, Cardozo L, Chapple C, Abrams P, Toozs-Hobson P, Young JS, Wyndaele JJ, De Wachter S, Campeau L, Gajewski JB. What are the causes and consequences of bladder overdistension? ICI-RS 2011. Neurourol Urodyn 2012; 31:317-21. [PMID: 22419355 DOI: 10.1002/nau.22224] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/13/2012] [Indexed: 12/16/2022]
Abstract
AIMS To report the outcome of the think tank on prolonged bladder overdistension from the 3rd ICI-RS meeting. METHODS Prolonged bladder overdistension was discussed after acute urinary retention, its terminology, its prevalence, pathophysiology, and consequences, as well as prophylactic and therapeutic aspects. RESULTS Acute prolonged bladder overdistension (ApBO) is a consequence of undetected or inadequately treated acute retention, and is mostly due to regional anesthesia, prolonged childbirth, or extensive surgery. Currently, there is no agreed terminology. A primary, temporary neurogenic detrusor dysfunction causing retention is associated with decreased or absent bladder sensation therefore patients do not complain, and management is delayed. Therapeutically, the first intervention is to drain the bladder. Recovery depends on whether reversible or irreversible damage has occurred. There are no good data to support the use of drugs or sacral neuromodulation. Intravesical electrostimulation is the only treatment that has specifically addressed this problem with encouraging results. There are no recent reports on the effect of surgery for myogenic bladder damage. CONCLUSION ApBO is an important, but often unrecognized medical complication. There is a need for defining the terminology, for studies to record the incidence of different types of bladder overdistension, and to establish management strategies. Apart from clean intermittent self catheterization (CIC) there are no data justifying pharmacological or other therapies. Therefore, prevention is of paramount importance and there is a need to develop and test preventative strategies, which should then be incorporated in surgical registries.
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Bladder Dysfunction after Gynecologic Laparoscopic Surgery for Benign Disease. J Minim Invasive Gynecol 2012; 19:76-80. [DOI: 10.1016/j.jmig.2011.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/21/2011] [Accepted: 09/27/2011] [Indexed: 11/15/2022]
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Joelsson-Alm E, Ulfvarson J, Nyman CR, Divander MB, Svensén C. Preoperative ultrasound monitoring can reduce postoperative bladder distension: a randomized study. ACTA ACUST UNITED AC 2011; 46:84-90. [PMID: 22150754 DOI: 10.3109/00365599.2011.637959] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether close preoperative ultrasound monitoring starting in the emergency room (ER) could prevent postoperative bladder distension among acute orthopaedic patients. MATERIAL AND METHODS A randomized controlled trial was conducted at a 650-bed level-2 centre in Sweden. Inclusion criteria were admittance via ER to an orthopaedic ward for acute surgery. Bladder volumes were measured with a portable ultrasound scanner (Bladderscan BVI 3000). In the intervention group, all patients were scanned in the ER and then regularly at the ward at predefined times until surgery. In the control group, no regular scanning was performed before surgery. During surgery, the same procedure was performed for both groups: bladder scanning immediately after arrival to the recovery room and continuous postoperative scanning until voiding. The primary outcome was postoperative bladder distension, defined as a bladder volume ≥500 ml. Secondary outcomes were postoperative urinary tract infection and hospital length of stay. RESULTS A total of 281 patients completed the study, 141 in the intervention group and 140 in the control group. Postoperative bladder distension was significantly higher in the control group (27.1% vs 17.0%; p = 0.045, 95% confidence interval 4.9-19.8) in the intention-to-treat, per-protocol and as-treated analyses. No statistical difference was found between the intervention group and the control group regarding the secondary outcomes. CONCLUSIONS Frequent bladder monitoring starting in the ER can reduce postoperative bladder distension among acute orthopaedic patients. A preoperative bladder monitoring protocol should be implemented early in the ER for all patients admitted for acute orthopaedic procedures.
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Affiliation(s)
- Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
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Shih P, Wong AP, Smith TR, Lee AI, Fessler RG. Complications of open compared to minimally invasive lumbar spine decompression. J Clin Neurosci 2011; 18:1360-4. [DOI: 10.1016/j.jocn.2011.02.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/22/2011] [Indexed: 10/17/2022]
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Hansen BS, Søreide E, Warland AM, Nilsen OB. Risk factors of post-operative urinary retention in hospitalised patients. Acta Anaesthesiol Scand 2011; 55:545-8. [PMID: 21418152 DOI: 10.1111/j.1399-6576.2011.02416.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-operative urinary retention (POUR) is most accurately determined by using ultrasound to measure bladder volume. The aim of this study was to define the risk factors of POUR in the recovery room in hospitalised patients. METHODS An ultrasound-determined bladder volume ≥400 ml at arrival in the recovery room was used to define POUR. Multivariate regression analysis was used to identify patient and system factors linked to POUR in 773 consecutive hospitalised patients who had undergone orthopaedic, abdominal, gynaecological or plastic surgery without an indwelling urinary catheter. RESULTS We found the incidence of POUR to be 13%. The lack of pre-operative voiding, use of regional anaesthesia, anaesthesia time >2 h and emergency surgery were all independent risk factors for POUR. CONCLUSIONS The detected incidence of POUR at arrival in the recovery room was rather high but had easily identifiable risk factors. We recommend pre-operative voiding whenever possible. Routine bladder scanning at arrival in the recovery room should be considered, especially after spinal anaesthesia, emergency surgery or when the anaesthesia time exceeds 2 h.
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Affiliation(s)
- B S Hansen
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Norway.
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Abstract
BACKGROUND Post-operative urinary retention, the inability to void following surgery despite a full bladder, is usually transitory but can be prolonged in some cases. It can lead to several complications including urinary tract infection, long term bladder dysfunction and kidney damage leading to chronic kidney disease. Catheterisation, generally regarded as the optimal management method, is associated with risks and so pharmacological treatment of post-operative urinary retention that could remove or reduce the need for catheterisation is desirable. OBJECTIVES To assess the effectiveness of drugs for treatment of post-operative urinary retention either alone or as an adjunct to catheterisation. SEARCH STRATEGY We searched the Cochrane Incontinence Group Specialised Register (searched 10 February 2010), CENTRAL (2010, Issue 1), MEDLINE (January 1950 to Week 1 January 2010), EMBASE (January 1980 to 2010 Week 5) and the reference lists of relevant articles. SELECTION CRITERIA Randomised and quasi randomised controlled trials in which at least one arm of the study included a drug treatment for post-operative urinary retention. DATA COLLECTION AND ANALYSIS Published reports of all potentially eligible studies were evaluated by two reviewers independently. No language or other limitations were applied. Standardised data extraction forms were used by two reviewers independently and cross-checked. Where insufficient data were reported authors were contacted where possible for further information. The risk of bias in eligible trials was assessed independently by two reviewers using the Cochrane risk of bias tool. MAIN RESULTS Seven studies including 494 participants formed the evidence base for this review. Drug treatments assessed in studies in the review included cholinergic agents, alpha-blockers, sedatives and prostaglandin on their own or in combinations. No statistically significant associations were reported between successful treatment or any other outcome and cholinergic agents, alpha-blockers and sedatives as monotherapies. A statistically significant association between intravesically administered prostaglandin and successful voiding was detected, Risk Ratio 3.07 (95% CI 1.22 to 7.72). A statistically significant association was detected between cholinergic agents combined with sedative and an improved likelihood of spontaneous voiding compared with placebo, Risk Ratio 1.39 (95% CI 1.07 to 1.82). Significant heterogeneity was identified between the two studies in this analysis, however. AUTHORS' CONCLUSIONS Whilst it may appear that cholinergic agents and intravesically administered prostaglandin offer most promise in the treatment of post-operative urinary retention, the evidence is weak. There is a need for further research into pharmacological alternatives to catheterisation in the treatment of this common surgical complication.
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Affiliation(s)
- Brian S Buckley
- Department of General Practice, National University of Ireland, Galway, Ireland
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Johansson RM, Christensson L. Urinary retention in older patients in connection with hip fracture surgery. J Clin Nurs 2010; 19:2110-6. [DOI: 10.1111/j.1365-2702.2010.03261.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yu D, Chai W, Sun X, Yao L. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth 2010; 57:843-8. [DOI: 10.1007/s12630-010-9338-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 05/14/2010] [Indexed: 10/19/2022] Open
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Kreutziger J, Frankenberger B, Luger T, Richard S, Zbinden S. Urinary retention after spinal anaesthesia with hyperbaric prilocaine 2% in an ambulatory setting. Br J Anaesth 2010; 104:582-6. [DOI: 10.1093/bja/aeq054] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jung H, Lee HH, Kim SH, Hur H, Song KY, Park CH, Jeon HM. Clinical Evaluation of Immediate Removal of Transurethral Catheter after Radical Gastrectomy: A Result of Feasibility Study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.3.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hun Jung
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Han Hong Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Soo Hong Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Hoon Hur
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Cho Hyun Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Hae Myung Jeon
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
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75
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Shadle B, Barbaro C, Waxman K, Connor S, Von Dollen K. Predictors of postoperative urinary retention. Am Surg 2009; 75:922-4. [PMID: 19886135 DOI: 10.1177/000313480907501012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postoperative urinary retention (PUR) rates vary greatly depending on the population studied. PUR leads to urinary tract instrumentation, which causes increased hospital costs and morbidity. We sought to determine our PUR rate and the risk factors that associated with it. One hundred seventy-six adult surgical inpatients were included in the study. Excluded were those receiving intraoperative catheterization, epidural anesthesia, and urologic procedures. The study population included 42 per cent spinal, 24 per cent laparoscopic abdominal, 20 per cent neck surgeries excluding the spine, and 14 per cent miscellaneous surgeries. Patient bladder volumes were determined using ultrasound scanning at three different intervals: a postvoid residual just before transfer to the operating suite, immediately on arrival in the recovery unit, and then immediately before transfer to the ward. Our overall rate of PUR was 5.7 per cent (10 of 176), defined as the need for catheterization during the postoperative hospitalization. Associated with PUR were advanced age (P = 0.0292) and postoperative bladder volume (P = 0.0246). Preoperative bladder volume, intraoperative fluid, and operative time did not reach statistical significance as being predictive of urinary retention. Our data suggest that PUR is associated with increased bladder volumes on arrival to the recovery room. A prospective study to determine whether identification of patients at risk will lead to decreased incidence of urinary tract infection is warranted.
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Affiliation(s)
- Benjamin Shadle
- Santa Barbara Cottage Hospital, Pueblo at Bath, Santa Barbara, CA 93105, USA.
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76
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Cabezón Gil P, López Yepes L, Fernández Pérez C, Barreales Tolosa L, Montoya González P, López Timoneda F. [Validity and reliability of bladder ultrasound imaging for noninvasive estimation of urine volume in a major outpatient surgery department]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:479-484. [PMID: 19994616 DOI: 10.1016/s0034-9356(09)70438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the validity and reliability of bladder ultrasound imaging for noninvasive estimation of urine volume, residual volume after voiding, volume before anesthetic induction and after surgery, and volume on sensing an urge to void. PATIENTS AND METHODS Study of a prospective series of 47 ASA 1-3 patients aged 18 to 79 years undergoing major outpatient surgical procedures under general anesthesia (n = 24) or regional anesthesia and sedation (n = 23). Urine volume was measured at baseline and on recovery (bladder volume by ultrasound and voided volume in a flask) and at the end of surgery (ultrasound only). The reliability and validity of the ultrasound estimation was calculated. RESULTS Agreement (intraclass correlation coefficient [ICC]) between 4 ultrasound-image estimations at baseline and the measured amount collected in a flask ranged from 0.70 to 0.86. The inter- and intra-measurement reliability was high, with ICC values greater than 0.80. The median error of estimation by ultrasound, with respect to measurement in the flask, was 23% at baseline and 29% after recovery. The amount in the flask was greater. CONCLUSIONS Ultrasound monitoring of urine in the bladder is reliable and valid, particularly for small volumes. The procedure is tolerated by patients.
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Affiliation(s)
- P Cabezón Gil
- Unidad de Cirugía Mayor Ambulatoria, Hospital Clínico San Carlos, Madrid.
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77
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Unilateral anesthesia does not affect the incidence of urinary retention after low-dose spinal anesthesia for knee surgery. Anesth Analg 2009; 109:986-7. [PMID: 19690278 DOI: 10.1213/ane.0b013e3181af406e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated whether unilateral low-dose spinal anesthesia may reduce the likelihood of postoperative urinary retention. Forty patients scheduled for knee arthroscopy randomly received bilateral (n = 20) or unilateral (n = 20) spinal anesthesia with 6-mg hyperbaric bupivacaine 0.5%. The incidence of urinary retention (>500 mL) assessed with an ultrasound device (Bladderscan) and subsequent temporary catherization was 7/20 patients in the bilateral versus 6/20 in the unilateral group (not significant). We concluded that unilateral low-dose spinal anesthesia does not further decrease the likelihood of urinary retention. Our results demonstrate the value and necessity of monitoring bladder volume postoperatively.
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78
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Darrah DM, Griebling TL, Silverstein JH. Postoperative Urinary Retention. Anesthesiol Clin 2009; 27:465-84, table of contents. [DOI: 10.1016/j.anclin.2009.07.010] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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79
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Joelsson-Alm E, Nyman CR, Lindholm C, Ulfvarson J, Svensén C. Perioperative bladder distension: A prospective study. ACTA ACUST UNITED AC 2009; 43:58-62. [PMID: 18979281 DOI: 10.1080/00365590802299122] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Claes R. Nyman
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | | | - Johanna Ulfvarson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Christer Svensén
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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80
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Wohlrab KJ, Erekson EA, Korbly NB, Drimbarean CD, Rardin CR, Sung VW. The association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures. Am J Obstet Gynecol 2009; 200:571.e1-5. [PMID: 19223025 DOI: 10.1016/j.ajog.2008.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 10/08/2008] [Accepted: 11/16/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to estimate the association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures. STUDY DESIGN We performed a retrospective cohort study of women undergoing outpatient midurethral sling procedures. Exposure was defined as the type of anesthesia, categorized as regional (spinal or combined spinal/epidural) or nonregional (general endotracheal, monitored anesthesia care with sedation, or local). The outcome, acute postoperative urinary retention, was defined as a failed voiding trial prior to discharge. RESULTS A total of 131 women met our inclusion criteria. Forty-two women (32%) had regional anesthesia and 89 (68%) women had non-regional anesthesia. Overall, 48 women (36.6%) had acute postoperative urinary retention. Women who had regional anesthesia had an increased odds (adjusted odds ratio, 4.4; 95% confidence interval, 1.9-10.2) of acute postoperative urinary retention compared with women receiving nonregional anesthesia. CONCLUSION Regional anesthesia is a risk factor for acute postoperative urinary retention following outpatient midurethral slings.
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Affiliation(s)
- Kyle J Wohlrab
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, RI, USA.
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81
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Belbachir A, Fletcher D, Larue F. Prise en charge de la douleur postopératoire : évaluation et amélioration de la qualité. ACTA ACUST UNITED AC 2009; 28:e1-12. [DOI: 10.1016/j.annfar.2008.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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82
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Feliciano T, Montero J, McCarthy M, Priester M. A Retrospective, Descriptive, Exploratory Study Evaluating Incidence of Postoperative Urinary Retention After Spinal Anesthesia and Its Effect on PACU Discharge. J Perianesth Nurs 2008; 23:394-400. [DOI: 10.1016/j.jopan.2008.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 08/09/2008] [Accepted: 09/17/2008] [Indexed: 11/29/2022]
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83
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A Study of Naloxone Effect on Urinary Retention in the Patient Receiving Morphine Patient-Controlled Analgesia. Orthop Nurs 2008; 27:111-5. [DOI: 10.1097/01.nor.0000315625.44137.4f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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84
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Sherburne E, Sawin K. Investigating time to void after lower-extremity orthopedic surgery in a pediatric population. J SPEC PEDIATR NURS 2008; 13:36-47. [PMID: 18096011 DOI: 10.1111/j.1744-6155.2008.00132.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to determine the time frame of postoperative bladder volume assessment in order to identify children at risk for urinary retention in a pediatric orthopedic population. DESIGN AND METHODS This is a descriptive and nonexperimental study. Variables included age, sex, length of anesthesia, type of analgesia, analgesia delivery, bladder volume, and intravenous fluid rate. RESULTS Twenty-nine percent of the children (n = 38) required straight catheterization. The average length of time to bladder emptying was 5 hr. There were significant correlations (p < .05) between several variables. PRACTICE IMPLICATIONS The standard practice of waiting 8 hr before assessment of voiding was not supported in this study.
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Affiliation(s)
- Eileen Sherburne
- Department of Advanced Practice Nursing and Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
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85
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Kim MG, Kim SI, Doo SW, Ok SY, Kim SC, Yang WJ. Effect of intraoperative remifentanil infusion on postoperative urinary retention. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mun-Gyu Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soon Im Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Si-young Ok
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sun Chong Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University College of Medicine, Seoul, Korea
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86
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Norberg A, Hahn RG, Li H, Olsson J, Prough DS, Børsheim E, Wolf S, Minton RK, Svensén CH. Population volume kinetics predicts retention of 0.9% saline infused in awake and isoflurane-anesthetized volunteers. Anesthesiology 2007; 107:24-32. [PMID: 17585212 DOI: 10.1097/01.anes.0000268387.34758.6d] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In previous work, extravascular expansion was observed to be enhanced by isoflurane anesthesia in sheep when a crystalloid bolus was administered. The aim of the current study was to further elaborate these investigations to humans and to explore the use of population kinetics in the analysis of fluid shifts. METHODS Eleven healthy volunteers participated in two experiments each, either awake or isoflurane anesthetized, during which they received 25 ml/kg saline, 0.9%, intravenously over 20 min. Plasma dilution data were derived from repeated sampling of hemoglobin concentration, and population pharmacokinetic analysis was conducted using the WinNonMix 2.0.1 software (Pharsight Corporation, Mountain View, CA). Plasma hormones were measured, and hemodynamic values were monitored. RESULTS Fluid infusion during isoflurane anesthesia was followed by a higher cardiac output, lower arterial pressure, and lower urinary excretion as compared with the awake protocol (P < 0.05). Albumin dilution was greater than hemoglobin concentration-derived plasma dilution, which indicates a transcapillary leak of albumin. A two-compartment model with an isoflurane-depressed, intercompartmental distribution parameter predicted that more than 50% of the infused volume was retained in the peripheral compartment at 180 min in both protocols. Isoflurane markedly increased the plasma levels of renin and aldosterone, whereas vasopressin was mostly unchanged. CONCLUSION Fluid retention after rapid infusion of 0.9% saline was prominent in both awake and isoflurane-anesthetized subjects. Altered kinetics of infused 0.9% saline during isoflurane anesthesia was expressed as reduced clearance and a slower distribution, resulting in a small but significant increase in fluid accumulation in the body fluid compartments. These changes may be due to the associated decreasing of mean arterial pressure and increased release of renin and aldosterone.
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Affiliation(s)
- Ake Norberg
- Karolinska Institute at Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
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87
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Hanson RA, Zornow MH, Conlin MJ, Brambrink AM. Laser Resection of the Prostate: Implications for Anesthesia. Anesth Analg 2007; 105:475-9. [PMID: 17646508 DOI: 10.1213/01.ane.0000270217.82825.1f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Holmium:yttrium-aluminum-garnet and potassium-titanyl-phosphate lasers make it possible to perform transurethral prostate resection with almost no absorption of irrigant and minimal blood loss. Subarachnoid block is usually administered for classical transurethral resection of the prostate, so that the patient can be monitored for the onset of transurethral resection of the prostate syndrome secondary to irrigant absorption. New laser resection techniques may allow the patient and anesthesiologist to choose options most appropriate for the patient's medical conditions and preference. In this study, we review the urologic literature to provide an overview of current laser technology for prostate reduction surgery. We also screened this literature for evidence of potential effects on anesthesia care for special patient groups as well as for overall perioperative management. Our findings suggest that the anesthesiologist may now safely offer general anesthesia for endourologic laser surgery, even on an ambulatory basis. This includes patients with cardiovascular disease or receiving continuous anticoagulation therapy. We found no studies specifically aimed at evaluating best anesthetic practices for patients undergoing laser procedures. Therefore, clinical research is needed to better define the risks and benefits of the various anesthetic alternatives.
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Affiliation(s)
- Richard A Hanson
- Department of Anesthesiology and Peri-Operative Medicine, Oregon Health and Science University, Portland, OR 97239, USA
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88
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Ostaszkiewicz J. Incomplete bladder emptying in frail older adults: a clinical conundrum. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2007. [DOI: 10.1111/j.1749-771x.2007.00019.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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89
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Kim JY, Lee SJ, Koo BN, Noh SH, Kil HK, Kim HS, Ban SY. The effect of epidural sufentanil in ropivacaine on urinary retention in patients undergoing gastrectomy. Br J Anaesth 2006; 97:414-8. [PMID: 16816394 DOI: 10.1093/bja/ael172] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although epidural opioids have excellent analgesic property, their side-effects limit its use in patient-controlled epidural analgesia (PCEA). This study was designed to compare side-effects of epidural sufentanil in ropivacaine with that of morphine in ropivacaine focusing on lower urinary tract function after major abdominal surgery. METHODS In total 60 patients undergoing gastrectomy were randomly allocated to receive either sufentanil in ropivacaine (Group S, n=30) or morphine in ropivacaine (Group M, n=30) for their PCEA. Epidural catheter was inserted between the 7th and 8th thoracic spine. Visual analogue pain score and side-effects such as nausea, vomiting, pruritus, hypotension and urinary retention were evaluated during postoperative days (PODs) 1 and 2 in the postanaesthetic care unit. RESULTS The incidence of serious to major micturition problem in Group S was lower than that in Group M (P<0.001). The incidence of pruritus, nausea and vomiting was also lower in Group S than in Group M on POD 1. CONCLUSIONS The lower incidence of major/serious micturition problem in patients receiving sufentanil in ropivacaine thoracic epidural analgesia suggests that continuation of urinary drainage may not be necessary from POD 1 onwards.
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Affiliation(s)
- J Y Kim
- Department of Anaesthesiology and Pain Medicine, Gachon Medical School Gil Medical Center Incheon, South Korea
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90
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Abstract
A combined strategy of anesthetic and surgical care defines postoperative rehabilitation, which aims to accelerate recovery from surgery, shorten convalescence, and reduce postoperative morbidity. Preoperative and early postoperative oral feeding, a relatively "dry" fluid regimen, and the avoidance of or early removal of drains, gastric tubes and bladder catheters all contribute to decreasing postoperative morbidity after abdominal surgery. Postoperative pain control, prevention of nausea and vomiting, shortening the duration of postoperative ileus, and early ambulation can also help to decrease postoperative morbidity. The use of multimodal fast-track clinical rehabilitation programs should improve outcomes and quality of life, reduce hospital stays, and save money.
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Affiliation(s)
- Francis Bonnet
- Département d'Anesthésie-Réanimation, Hôpital Tenon, Paris.
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91
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Lepousé C, Lautner CA, Liu L, Gomis P, Leon A. Emergence delirium in adults in the post-anaesthesia care unit. Br J Anaesth 2006; 96:747-53. [PMID: 16670111 DOI: 10.1093/bja/ael094] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Emergence delirium in the post-anaesthesia care unit (PACU) is poorly understood. The goal of this prospective study was to determine frequency and risk factors of emergence delirium in adults after general anaesthesia. METHODS In this prospective study, 1,359 consecutive patients were included. Contextual risk factors and occurrence of delirium according to the Riker sedation scale were documented. Groups were defined for the analysis according to the occurrence or not of agitation, then after exclusion of patients with preoperative anxiety and neuroleptics, or both, and antidepressants or benzodiazepines treatments. RESULTS Sixty-four (4.7%) patients developed delirium in the PACU, which can go from thrashing to violent behaviour and removal of tubes and catheters. Preoperative anxiety was not found to be a risk factor. Preoperative medication by benzodiazepines (OR=1.910, 95% CI=1.101-3.315, P=0.021), breast surgery (OR=5.190, 95% CI=1.422-18.947, P=0.013), abdominal surgery (OR=3.206, 95% CI=1.262-8.143, P=0.014), and long duration of surgery increased the risk of delirium (OR=1.005, 95% CI=1.002-1.008, P=0.001), while a previous history of illness and long-term treatment by antidepressants decreased the risk (respectively, OR=0.544, 95% CI=0.315-0.939, P=0.029 and OR=0.245, 95% CI=0.084-0.710, P=0.010). CONCLUSIONS Preoperative benzodiazepines, breast and abdominal surgery and surgery of long duration are risk factors for emergence delirium.
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Affiliation(s)
- C Lepousé
- Department of Anaesthesiology and Intensive Care, Hôpital Robert Debré CHU Reims, REIMS Cedex, F-51092, France.
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92
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Koch CA, Grinberg GG, Farley DR. Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg 2006; 191:381-5. [PMID: 16490551 DOI: 10.1016/j.amjsurg.2005.10.042] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 10/28/2005] [Accepted: 10/28/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postoperative urinary retention (PO-UR) frequently complicates the repair of inguinal hernias. The purpose of this study was to determine the incidence of and risk factors for developing PO-UR in patients undergoing endoscopic inguinal hernia repair. METHODS The incidence of PO-UR was determined by a retrospective review of a prospective patient database for all patients undergoing inguinal hernia repair by 1 surgeon from 2001 to 2003 at a tertiary referral center. A case-control study was used to identify risk factors for the development of PO-UR. RESULTS Thirty-four (22.2%) out of 153 patients undergoing endoscopic inguinal hernia repair developed PO-UR. The use of narcotic analgesia and the volume of intravenous postoperative fluid administered were significant risk factors (P < .05) for the development of PO-UR. CONCLUSIONS Postoperative urinary retention is common after totally extraperitoneal and transabdominal preperitoneal inguinal hernia repairs and is associated directly with increased narcotic and postoperative intravenous fluid administration.
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Affiliation(s)
- Cody A Koch
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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93
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Kim YJ, Lee HJ, Lee T. The Accuracy and Diagnostic Value of Three-Dimensional Portable Bladder Volume Measurement System in the Measurement of Bladder Volume according to the Different Angling of Ultrasound Transducer. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.12.1320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yong-Jin Kim
- Department of Urology, Inha University College of Medicine, Incheon, Korea
| | - Hun-Jae Lee
- Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon, Korea
| | - Tack Lee
- Department of Urology, Inha University College of Medicine, Incheon, Korea
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Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, Desmonts JM. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg 2005; 101:592-596. [PMID: 16037182 DOI: 10.1213/01.ane.0000159165.90094.40] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Urinary retention is a common postoperative complication associated with bladder overdistension and the risk of permanent detrusor damage. The goal of this study was to determine predictive factors of early postoperative urinary retention in the postanesthesia care unit (PACU). We prospectively collected, in 313 adult patients, variables including age, gender, previous history of urinary tract symptoms, type of surgery and anesthesia, intraoperative administration of anticholinergics, amount of intraoperative fluids, IV morphine titration, and bladder volume on entry to the PACU. For each patient, bladder volume was measured by ultrasound on entry and before discharge from the PACU. Urinary retention was defined as a bladder volume larger than 600 mL with an inability to void within 30 min. Predictive factors were identified by multivariate analysis. The incidence of urinary retention in the PACU was 16%. In the multivariate analysis only the amount of intraoperative fluids (>or=750 mL; P = 0.02; odds ratio = 2.3), age (>or=50 yr; P = 0.008; odds ratio = 2.4), and bladder volume on entry to PACU (>or=270 mL; P = 0.0001; odds ratio = 4.8) were found to independently increase the risk of urinary retention. Considering the clinical impact of undiagnosed postoperative urinary retention, these results suggest systematic evaluation of bladder volume with a portable ultrasound device in the PACU, especially in patients with risk factors. IMPLICATIONS In this observational study, the ultrasound monitoring of bladder volume in the postanesthesia care unit (PACU) revealed that postoperative urinary retention occurred with an incidence of 16%. Age (>or=50 yr), amount of intraoperative fluid volume (>or=750 mL), and bladder volume on entry to PACU (>or=270 mL) were independent predictive factors for this complication.
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Affiliation(s)
- Hawa Keita
- Department of Anesthesiology and Intensive Care, Hospital Bichat-Claude Bernard, Paris, France
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