1
|
Chen LJ, Chen SH, Hsieh YL, Yu PC. Continuous nerve block versus thoracic epidural analgesia for post-operative pain of pectus excavatum repair: a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:266. [PMID: 37559029 PMCID: PMC10410789 DOI: 10.1186/s12871-023-02221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Surgery to repair pectus excavatum (PE) is often associated with severe postoperative pain, which can impact the length of hospital stay (LOS). While thoracic epidural analgesia (TEA) has traditionally been used for pain management in PE, its placement can sometimes result in severe neurological complications. Recently, paravertebral block (PVB) and erector spinae plane block (ESPB) have been recommended for many other chest and abdominal surgeries. However, due to the more severe and prolonged pain associated with PE repair, it is still unclear whether continuous administration of these blocks is as effective as TEA. Therefore, we conducted this systematic review and meta-analysis to demonstrate the equivalence of continuous PVB and ESPB to TEA.
Collapse
Affiliation(s)
- Li-Jung Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan
| | - Shih-Hong Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan
| | - Yung-Lin Hsieh
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan
| | - Po-Chuan Yu
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan.
| |
Collapse
|
2
|
Beeler C, Dbeibo L, Yeap YL, Porter H, Beeson T, Schmidt CM, House MG, Glossenger A, Kelley K, Birdas TJ. Real world utilization of nurse-driven urinary catheter removal protocol in patients with epidural pain catheters. Am J Infect Control 2022; 50:396-399. [PMID: 34551336 DOI: 10.1016/j.ajic.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Surgeons use indwelling bladder catheters (IBCs) to avoid urinary retention in patients with epidural analgesic catheters. Reduction of IBC-days is associated with improved catheter-associated urinary tract infection rates (CAUTI). This study investigates real world application of a Nurse-Driven Catheter Removal Protocol (NDCRP) to reduce IBC-days in this patient population. METHODS Patients with epidural catheters and IBC were targeted for IBC removal on post-operative day 1 (POD1). Patients were followed for application of the NDCRP, catheterization need, IBC re-anchoring, and complications. RESULTS One hundred and thirty-three patients had IBCs removed on POD1 (Protocol Group) and 50 patients did not (Non-Protocol Group). There was a reduction in IBC-days in the Protocol Group despite incomplete adherence to the NDCRP (1.55 days vs 4.64 days; P < .001). Ninety-three patients (70%) were able to spontaneously void after early IBC removal. Fourteen patients (11%) were able to spontaneously void after serial in-and-out catheterization (I/O). No significant difference in re-anchoring was found between the protocol and non-protocol groups (26 vs 4 patients; P = .09). CONCLUSIONS Early removal of IBCs (POD1) in patients with epidural catheters with the assistance of an NDCRP is a safe and successful strategy to reduce IBC-days in the hospital.
Collapse
|
3
|
McGinigle KL, Spangler EL, Pichel AC, Ayyash K, Arya S, Settembrini AM, Garg J, Thomas MM, Dell KE, Swiderski IJ, Lindo F, Davies MG, Setacci C, Urman RD, Howell SJ, Ljungqvist O, de Boer HD. Perioperative care in open aortic vascular surgery: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery. J Vasc Surg 2022; 75:1796-1820. [PMID: 35181517 DOI: 10.1016/j.jvs.2022.01.131] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022]
Abstract
The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS®) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based recommendations related to all of the health care received in the perioperative period for patients undergoing open abdominal aortic operations (both transabdominal and retroperitoneal approaches, including supraceliac, suprarenal, and infrarenal clamp sites, for aortic aneurysm and aortoiliac occlusive disease). Structured around the ERAS® core elements, 36 recommendations were made and organized into preadmission, preoperative, intraoperative, and postoperative recommendations.
Collapse
Affiliation(s)
- Katharine L McGinigle
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Emily L Spangler
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Adam C Pichel
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Katie Ayyash
- Department of Perioperative Medicine (Merit), York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Shipra Arya
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | | | - Joy Garg
- Department of Vascular Surgery, Kaiser Permanente San Leandro, San Leandro, CA
| | - Merin M Thomas
- Lenox Hill Hospital, Northwell Health, New Hyde Park, NY
| | | | | | - Fae Lindo
- Stanford University Hospital, Palo Alto, CA
| | - Mark G Davies
- Department of Surgery, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Sciences Center, San Antonio, TX
| | - Carlo Setacci
- Department of Surgery, University of Siena, Siena, Italy
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Simon J Howell
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Olle Ljungqvist
- Department of Surgery, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedure Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands
| |
Collapse
|
4
|
Alwatari Y, Scheese D, Rustom S, Sevdalis AE, Ayalew D, Julliard W, Shah RD. Trends in open lobectomy outcomes for lung cancer over the last 15 years: national cohort. Gen Thorac Cardiovasc Surg 2021; 70:144-152. [PMID: 34510333 DOI: 10.1007/s11748-021-01703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Adoption of thoracoscopic lobectomy has been increasing in the US; however, open lobectomy (OL) is still performed in half of the cases. Postoperative care and enhanced recovery after surgery (ERAS) pathways have evolved and improved outcomes. The study aims to evaluate postoperative outcomes of OL over the last 15 years. METHODS Patients who underwent lobectomy for lung cancer between 2005 and 2019 were identified in the National Surgical Quality Improvement Program and divided into three groups; pre-ERAS (2005-2011), transitional period (2012-2015), and wider ERAS implementation (2016-2019). Preoperative characteristics and postoperative outcomes were compared and multivariable regression analysis was constructed to assess independent predictors of outcomes. RESULTS OL was comprised of 40% of lobectomies for lung cancer. 10,021 patients met inclusion criteria. 49% were males and mean age was 67. Patients who belonged to the (2016-2019) period group had significantly higher comorbidities and ASA classification. General surgeons performed < 10% of OL in 2016-2019 compared to over 30% during 2005-2011. Patients in the 2016-2019 period were less likely to experience unplanned intubation, surgical site infections, and sepsis. Mortality was also significantly lower than the previous groups (1.9% vs 2.0% and 2.8%, p = 0.05). The rate of discharge to facility as well as length of hospital stays improved over the years. The surgeon specialty served as an independent predictor for length of stay, unplanned intubation, and home discharge. CONCLUSION The outcomes of OL are improving over the years. Increasing number of these surgeries being performed by dedicated thoracic surgeons and ERAS pathways are likely helping improve outcomes.
Collapse
Affiliation(s)
- Yahya Alwatari
- Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA.
| | - Daniel Scheese
- Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA
| | - Salem Rustom
- Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA
| | - Athanasios E Sevdalis
- Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA
| | - Dawit Ayalew
- Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA
| | - Walker Julliard
- Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA
| | - Rachit D Shah
- Department of Surgery, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA, 23298, USA
| |
Collapse
|
5
|
Campos MG, Peixoto AR, Fonseca S, Santos F, Pinho C, Leite D. Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort. Braz J Anesthesiol 2021; 72:605-613. [PMID: 33887339 PMCID: PMC9515676 DOI: 10.1016/j.bjane.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
Collapse
Affiliation(s)
- Marta G Campos
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal.
| | - Ana R Peixoto
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Sara Fonseca
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Francisca Santos
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Cristiana Pinho
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| | - Diana Leite
- Hospital Universitário São João, Departamento de Anestesiologia, Porto, Portugal
| |
Collapse
|
6
|
Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care. Perioper Med (Lond) 2020; 9:31. [PMID: 33106758 PMCID: PMC7582032 DOI: 10.1186/s13741-020-00159-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
Collapse
Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padova, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, 'V Fazzi' Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
| | | |
Collapse
|
7
|
Knight BA, Bayne AP, Zusman N, Barney N, Yang S. Postoperative management factors affect urinary retention following posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2020; 8:703-709. [PMID: 32077085 DOI: 10.1007/s43390-020-00090-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study investigates postoperative urinary retention (POUR) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and the effects of postoperative analgesia and mobility on retention. High opioid use and decreased postoperative mobility are proposed risk factors for retention in adults. There is a paucity of literature on POUR in the adolescent population undergoing surgery for AIS. The impact of pain control and mobility on POUR in these patients is unknown. METHODS A retrospective cohort study was conducted of adolescents (11-18 years) undergoing elective PSF for AIS at a single institution (2012-2018). POUR was defined as the inability to void > 8 h after catheter removal. Possible risk factors for retention including opioid usage and ambulatory status at the time of catheter removal were assessed on univariate and binomial logistic regression analyses. RESULTS One hundred and thirty-six patients were included, with 21 (15.4%) experiencing POUR. On the day of catheter removal, 24 patients had not attempted ambulation; these patients had 2.5 times higher rate of POUR than those who were walking (30% vs. 12%, p = 0.04). Patients who developed retention ambulated a mean threefold shorter distance than those without POUR (45 vs. 136 feet, p = 0.04). On binomial logistic regression, decreased ambulation distance was associated with retention (p = 0.038). While opioid use was not significant on univariate analysis, higher opioid use on the day of catheter removal predicted retention on logistic regression (p = 0.001). POUR resolved in all patients (median duration 0.5 days, range 0-12 days). CONCLUSIONS The development of POUR after PSF for AIS affects one in six patients but resolves quickly. Non-ambulatory patients and patients who received large doses of opioids on the day of catheter removal were more likely to develop POUR. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- B Alexander Knight
- Department of Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA
| | - Aaron P Bayne
- Department of Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA
| | - Natalie Zusman
- Department of Orthopaedics, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW6, Portland, OR, 97239, USA
| | - Nicole Barney
- Department of Orthopaedics, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW6, Portland, OR, 97239, USA
| | - Scott Yang
- Department of Orthopaedics, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW6, Portland, OR, 97239, USA.
| |
Collapse
|
8
|
Giang NT, Van Nam N, Trung NN, Anh LV, Cuong NM, Van Dinh N, Pho DC, Geiger P, Kien NT. Patient-controlled paravertebral analgesia for video-assisted thoracoscopic surgery lobectomy. Local Reg Anesth 2018; 11:115-121. [PMID: 30538541 PMCID: PMC6255283 DOI: 10.2147/lra.s184589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Paravertebral block has been proven to be an efficient method to provide post-thoracotomy pain management. This study aimed to compare patient-controlled paravertebral analgesia (PCPA) and intravenous patient-controlled analgesia (IVPCA) in terms of analgesic efficiency, respiratory function, and adverse effects after video-assisted thoracoscopic surgery (VATS) lobectomy. Patients and methods The prospective randomized trial study was carried out on 60 patients who underwent VATS lobectomy (randomly allocated 30 patients in each group). In the PCPA group, an initial dose of 0.3 mL/kg of 0.125% bupivacaine with fentanyl 2 µg/mL was administered, followed by a 3 mL/h continuous infusion with patient-controlled analgesia (2 mL bolus, 10-minute lockout interval, 25 mL/4 h limit). In the IVPCA group with morphine 1 mg/mL solution, an infusion device was programmed to deliver a 1.0 mL demand bolus with no basal infusion rate, with a 10-minute lockout interval and a maximum of 20 mL/4 h period. Postoperative pain was assessed by visual analog scale at rest and on coughing. Arterial blood gas and spirometry were monitored and recorded for the first 3 postoperative days. Side effects to include were also recorded. Results The PCPA group had statistically significant lower pain scores (P<0.0001) at rest at all times. Lower pain scores on coughing were statistically significant in PCPA group in the first 4 hours. Postoperative spirometry showed that both the groups had comparable recovery trajectories for their pulmonary function. Arterial blood gas analysis showed pH and PaCO2 were in a normal range in both the groups. The incidence of headache was higher in the IVPCA group (13.3% vs 0%; P=0.038). Conclusion PCPA effectively managed pain after VATS lobectomy, with lower pain scores, similar respiratory function, and fewer side effects than standard IVPCA treatment.
Collapse
Affiliation(s)
- Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Van Nam
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Ngoc Trung
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Viet Anh
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Manh Cuong
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Ngo Van Dinh
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Dinh Cong Pho
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Phillip Geiger
- Department of Anesthesiology, Perioperative, and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Nguyen Trung Kien
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| |
Collapse
|
9
|
Li S, Jiang L, Ang KL, Chen H, Dong Q, Yang H, Li J, He J. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg 2017; 51:689-693. [PMID: 28007874 DOI: 10.1093/ejcts/ezw364] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/16/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives Problems associated with intubation, chest drainage and urinary catheterization can have a negative impact on patient's recovery after thoracic surgery. We therefore evaluated the feasibility of a new tubeless (spontaneous ventilation without tracheal intubation, urinary catheterization, and no post-operative chest drain placement) approach to perform video-assisted thoracoscopic surgery (VATS) for small pulmonary nodules (SPN) less than 2cm in diameter. Methods From 1 January 2012 to 31 December 2014, 34 patients with SPNs were treated using tubeless VATS in our centre. To be eligible for this approach, the patient must have a body mass index (BMI) of less than 25; ASA grade of II or less; no history of prostate or renal disease and no parenchymal air leak at the end of surgery. All operations were performed via an anterior uniportal VATS under spontaneous ventilation without tracheal intubation. Results All patients [29 male:5 females; average age: 58 ± 19 years old] completed their operation under spontaneous ventilation, without conversion to endotracheal intubation. There was good operative exposure and definite diagnosis was obtained in all patients. The anaesthesia and operating time were 23 ± 3 min and 43 ± 10 min, respectively. No major intra-operative or post-operative complications were seen. Patients recovered from their anaesthesia (fully awake) within a mean time of 18 ± 3 min after surgery, and were eating 42 normally on an average of 5 ± 1 h post-operatively. No patients had pain on deep breathing or coughing (Bruggemann Comfort Score < 2). Within 24 h after surgery, 26 patients were discharged, while the remaining 8 patients were discharged on the second day. None of the patients needed re-invention with chest drainage or urinary catheterization even after discharge. All patients remained well at a median [interquartile range] follow-up time of 3[2-5] weeks. Conclusions Tubeless VATS approach for SPNs is feasible in carefully selected patients. Intubation, chest drainage, and/or urinary catheterization may not be necessary in all patients.
Collapse
Affiliation(s)
- Shuben Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Long Jiang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Keng-Leong Ang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Hanzhang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Qinglong Dong
- State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hanyu Yang
- State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jingpei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Diseases, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| |
Collapse
|
10
|
Brand J. Sedation and Analgesia. PHARMACEUTICAL SCIENCES 2017. [DOI: 10.4018/978-1-5225-1762-7.ch019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patients in the cardiothoracic intensive care unit (CTICU) are subject to numerous physical and mental stresses. While most of these cannot be completely eliminated, intensivists have many tools in their armamentarium to alleviate patients' pain and suffering. This chapter will consider the importance of analgesia and sedation in the CTICU and the relevant consequences of over- or under-treatment. We will examine the tools available for monitoring and titrating analgesia and sedation in critically ill patients. The major classes of medications available will be reviewed, with particular attention to their clinical effects, metabolism and excretion, and hemodynamic characteristics. Lastly, experimental evidence will be assessed regarding the best strategies for treatment of pain and agitation in the CTICU, including use of non-pharmacologic adjuvants.
Collapse
Affiliation(s)
- Jordan Brand
- San Francisco VA Medical Center, USA & University of California – San Francisco, USA
| |
Collapse
|
11
|
Optimal Timing of Urinary Catheter Removal After Thoracic Operations: A Randomized Controlled Study. Ann Thorac Surg 2016; 102:925-930. [DOI: 10.1016/j.athoracsur.2016.03.115] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/27/2016] [Accepted: 03/31/2016] [Indexed: 11/20/2022]
|
12
|
Hu Y, Craig SJ, Rowlingson JC, Morton SP, Thomas CJ, Persinger MB, Isbell J, Lau CL, Kozower BD. Early removal of urinary catheter after surgery requiring thoracic epidural: a prospective trial. J Cardiothorac Vasc Anesth 2016; 28:1302-6. [PMID: 25281046 DOI: 10.1053/j.jvca.2014.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To prevent urinary retention, urinary catheters commonly are removed only after thoracic epidural discontinuation after thoracotomy. However, prolonged catheterization increases the risk of infection. The purpose of this study was to determine the rates of urinary retention and catheter-associated infection after early catheter removal. DESIGN This study described a prospective trial instituting an early urinary catheter removal protocol compared with a historic control group of patients. SETTING The protocol was instituted at a single, academic thoracic surgery unit. PARTICIPANTS The study group was comprised of patients undergoing surgery requiring thoracotomy who received an intraoperative epidural for postoperative pain control. INTERVENTIONS An early urinary catheter removal protocol was instituted prospectively, with all catheters removed on or before postoperative day 2. Urinary retention was determined by bladder ultrasound and treated with recatheterization. MEASUREMENTS AND MAIN RESULTS The primary outcomes were urinary retention rate, defined as bladder volume>400 mL, and urinary tract infection rate. Results were compared with a retrospective cohort of 210 consecutive patients who underwent surgery before protocol initiation. Among the 101 prospectively enrolled patients, urinary retention rate was higher (26.7% v 12.4%, p = 0.003), while urinary tract infection rate improved moderately (1% v 3.8%, p = 0.280). CONCLUSIONS Early removal of urinary catheters with thoracic epidurals in place is associated with a high incidence of urinary retention. However, an early catheter removal protocol may play a role in a multifaceted approach to reducing the incidence of catheter-associated urinary tract infections.
Collapse
Affiliation(s)
- Yinin Hu
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Sarah J Craig
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - John C Rowlingson
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Steve P Morton
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA
| | - Christopher J Thomas
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Matthew B Persinger
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - James Isbell
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA; Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Christine L Lau
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Benjamin D Kozower
- Department of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
| |
Collapse
|
13
|
Forget P, Veevaete L, Lois F, De Kock M, Remue C, Leonard D, Kartheuser A. Is Urinary Drainage Necessary in Patients With Thoracic Epidural Analgesia? A Prospective Analysis. J Cardiothorac Vasc Anesth 2015; 29:e30-1. [DOI: 10.1053/j.jvca.2015.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Indexed: 11/11/2022]
|
14
|
Zaouter C, Ouattara A. How Long Is a Transurethral Catheter Necessary in Patients Undergoing Thoracotomy and Receiving Thoracic Epidural Analgesia? Literature Review. J Cardiothorac Vasc Anesth 2015; 29:496-501. [DOI: 10.1053/j.jvca.2014.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 12/17/2022]
|
15
|
Kim KW, Lee JI, Kim JS, Lee YJ, Choi WJ, Jung H, Park KY, Park CH, Son KH. Risk factors for urinary retention following minor thoracic surgery. Interact Cardiovasc Thorac Surg 2015; 20:486-92. [DOI: 10.1093/icvts/ivu445] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
16
|
Abstract
After colorectal resection surgery, early urinary catheter removal has been promoted as a part of the national Surgical Care Improvement Project. However, the decrease in urinary tract infection expected with this strategy must be balanced against an increased risk for urinary retention. A systematic review of the literature was undertaken to summarize the evidence for and against early postoperative urinary catheter removal. For nonpelvic colorectal resection, the evidence supports removal of the catheter on postoperative day 1 for patients who are not at high risk for urinary retention, including patients with thoracic epidurals. For mid-to-low rectal surgery, the risk of urinary retention is increased, and catheter removal on day 3 to day 6 is recommended; however, the exact timing of removal cannot be recommended based on current studies.
Collapse
Affiliation(s)
- Samantha Hendren
- Division of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
17
|
|
18
|
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.
Collapse
|
19
|
Stubbs BM, Badcock KJM, Hyams C, Rizal FE, Warren S, Francis D. A prospective study of early removal of the urethral catheter after colorectal surgery in patients having epidural analgesia as part of the Enhanced Recovery After Surgery programme. Colorectal Dis 2013; 15:733-6. [PMID: 23331852 DOI: 10.1111/codi.12124] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/26/2012] [Accepted: 10/19/2012] [Indexed: 12/13/2022]
Abstract
AIM Early removal of the urethral catheters is part of the enhanced postoperative recovery programme (ERAS). The effect of epidural anaesthesia on urinary retention was investigated in patients after colorectal resection. METHOD A prospective cohort study of all patients having colorectal surgery within an ERAS programme that included insertion of an epidural catheter over the last 5 years. RESULTS Two-hundred and ten patients had an epidural and a urethral catheter postoperatively. The duration of catheterization was not recorded in one patient who was therefore excluded from the study. One-hundred and eighteen patients had a trial without catheter (TWOC) prior to stopping the epidural (early TWOC). Ninety-one patients had TWOC after the epidural was stopped (late TWOC). Sixteen (7.6%) patients went into urinary retention (14 early TWOC and two late TWOC). The rate of urinary retention in the early TWOC group was significantly higher than that in the late TWOC group (11.9% vs 2.2%; χ(2), P = 0.009). Those who underwent a laparoscopic resection were significantly more likely to have undergone an early TWOC (χ(2), P = 0.001); however, there was no difference in retention rates between open and laparoscopic surgery (χ(2), P = 0.402). Pelvic surgery was not significantly associated with an increased risk of postoperative urinary retention (χ(2), P = 0.627). Male sex was not significantly associated with urinary retention (χ(2), P = 0.087). In the early TWOC group 86% had the catheter removed within 24 hours of surgery. CONCLUSION Early TWOC with epidural analgesia running significantly increases the risk of urinary retention; however, it was still successful in 88% of patients.
Collapse
Affiliation(s)
- B M Stubbs
- Department of Colorectal Surgery, Chase Farm Hospital, Barnet and Chase Farm Hospital Trust, The Ridgeway, Enfield, Middlesex, UK.
| | | | | | | | | | | |
Collapse
|
20
|
Zhu Z, Wang C, Xu C, Cai Q. Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial. Gastric Cancer 2013; 16:193-200. [PMID: 22806415 DOI: 10.1007/s10120-012-0168-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 05/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-controlled epidural analgesia (PCEA) has not been widely used after gastrectomy, although, in other abdominal surgery, it benefits patients more than patient-controlled intravenous analgesia (PCIA). We attempted to determine the effect of PCEA compared with PCIA on postoperative pain control and recovery after gastrectomy for gastric cancer. METHODS A randomized controlled clinical trial that included patients undergoing D2 radical gastrectomy for gastric cancer was conducted for this study. Patients were randomized to a morphine-bupivacaine PCEA group and a morphine PCIA group. Postoperative outcomes such as pain, fasting blood glucose (FBG), time to first passage of flatus, complications, and time staying in hospital after surgery were compared with an intention-to-treat analysis. RESULTS Between March 2010 and October 2010, 67 patients were randomized and 60 were evaluated. The PCEA group showed lower pain scores both at rest and on coughing after the operation (P < 0.05). FBG after the operation was significantly lower in the PCEA group than that in the PCIA group (P < 0.05). Time to first passage of flatus after surgery was shorter in the PCEA group (P < 0.05), while there were no significant differences regarding the incidence of complications between the two groups in terms of the clinical records. The length of hospital stay in the PCEA group was 10.7 ± 1.7 days, which was significantly shorter than that in the PCIA group (11.9 ± 1.8 days, P < 0.05). CONCLUSIONS After gastrectomy for gastric cancer, PCEA, compared with PCIA, offered safer pain relief with superior pain control and resulted in a lower stress response and a quicker return of bowel activity.
Collapse
Affiliation(s)
- Zhenxin Zhu
- Gastro-intestine Surgery Department, Shanghai Changzheng Hospital, 415 FengYang Road, Shanghai, 200003, People's Republic of China
| | | | | | | |
Collapse
|
21
|
ZAOUTER C, WUETHRICH P, MICCOLI M, CARLI F. Early removal of urinary catheter leads to greater post-void residuals in patients with thoracic epidural. Acta Anaesthesiol Scand 2012; 56:1020-5. [PMID: 22524633 DOI: 10.1111/j.1399-6576.2012.02701.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND A recent study showed that the removal of a bladder catheter is safe in presence of thoracic epidural analgesia (TEA). However, the ability to void satisfactorily can be affected. The aim of this investigation is to determine whether patients with TEA are able to recover the micturition process. METHODS On the morning after the surgery patients were randomised into two groups: the early removal group (ERG) (n = 101), with the bladder catheter removed at the same time, and the standard group (SG) (n = 104), where the bladder catheter was kept as long as TEA was functioning (on average 3-5 days after surgery). Following the first micturition, patients underwent regular ultrasound scanning of the bladder until a post-void residual (PVR) less than 200 ml was reached. RESULTS All of the patients in the ERG and in the SG started to void and recovered satisfactorily their ability to void, reaching a PVR < 200 ml without requiring a transurethral catheterisation. However, the length of time to reach a PVR < 200 ml in the ERG was significantly longer compared with the SG (345 min ± 169 vs. 207 min ± 122, P < 0.0001). CONCLUSION In the presence of TEA, the removal of the bladder catheter on the morning after surgery leads to a transient impairment of the lower urinary tract function with no need for re-catheterisation.
Collapse
Affiliation(s)
- C. ZAOUTER
- Department of Anesthesia; University of Pisa; Pisa; Italy
| | - P. WUETHRICH
- University Department of Anaesthesiology and Pain Therapy; Inselspital; Berne; Switzerland
| | - M. MICCOLI
- Epidemiology and Biostatistics Unit's Research; Department of Experimental Pathology M.B.I.E.; University of Pisa; Pisa; Italy
| | - F. CARLI
- Department of Anesthesia; McGill University Health Centre; Montreal; QC; Canada
| |
Collapse
|
22
|
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]
|
23
|
Affiliation(s)
- Mona Sawhney
- Acute Pain Service, North York General Hospital, Toronto, Ontario
| |
Collapse
|
24
|
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.
Collapse
Affiliation(s)
- Stephen Choi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | | | | |
Collapse
|
25
|
Postvoid Residuals Remain Unchanged in Patients With Postoperative Thoracic Epidural Analgesia After Thoracotomy. Reg Anesth Pain Med 2011; 36:46-50. [DOI: 10.1097/aap.0b013e3182030828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|