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A1379
October 15, 2007 2:00 PM - 4:00 PM Room Hall D, Area N, |
| Urinary Retention during Continuous Epidural Infusion of Local Anesthetics for Chronic Pain |
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Ai Hashimoto, M.D., Katsushi Doi, M.D., Tatsuya Hashimoto, M.D., Hiroyuki Kushizaki, M.D., Yoji Saito, M.D. Deparment of Anesthesiology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan |
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Background: Urinary retention is a common complication after surgery and anesthesia. Several mechanisms are involved, including sphincter spasm, bladder neck obstruction, and paralysis of the detrusor muscle. In addition, epidural analgesia using opioid and local anesthetics has been reported to promote intrapartum and postoperative urinary retention 1)2). Continuous epidural infusion of local anesthetics is one of the effective methods for management of chronic pain syndromes. There is little information available on the incidence of urinary retention in patients who treated with continuous epidural analgesia (CEA) without opioid. In this retrospective study, we evaluate the impact of method of CEA on the incidence of urinary retention during management of chronic pain. Methods: With IRB approval and informed consent, patients requireing continuous epidural infusion of local anesthetics for chronic pain between 4/1/2004 to 2/28/2007 were enrolled in this study. All patients received ropivacaine (0.25%) or mepivacaine (1%) using PCA pump with continuous infusion from 1 to 3 ml/hr. Individual patient charts were reviewed to compare the incidence of urinary retention with respect to patient demographic data, analgesic techniques and the use of antidepressants. Stastical analysis performed using chi-square test and P<0.05 was considered significant. Results: The study included 165 patients of which 51% (N=84) were male and 49% (N=81) were female. Of the 165 patients, 16 (9.7%) had urinary retention requiring bladder catheterization. All of the urinary retention resolved by the interruption of epidural local anesthetics. There was significant difference between male (N=13, 15.5%) and female (N=3, 3.7%) patients. There were no significant relationships in the presence of urological disease, the use of antidepressants and the choice of anesthetic agent. The incidence of urinary retention during cervical, thoracic and lumbar epidural analgesia was 0%, 13.7% and 9.8%, respectively. Conclusions: Our result suggests that urinary retention during CEA without opioid is not a rare occurrence (9.7%). Urinary retention is associated with male patient and thorcic or lumbar epidural analgesia. References : 1) Acta Anaesthesiol Scand 50:1297-303, 2006 2) Br J Anaesth 97:414-8, 2006. Anesthesiology 2007; 107: A1379 |