Detrusor Activity Is Impaired during Thoracic Epidural Analgesia after Open Renal Surgery

Wuethrich, Patrick Y.; Kessler, Thomas M.; Panicker, Jalesh N.; Curatolo, Michele; Burkhard, Fiona C.

doi:10.1097/aln.0b013e3181d4f4fe

Cited by 17 publications

(10 citation statements)

References 37 publications

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“…27,58,61,63 Urinary tract infection Thirteen of the 94 studies included in this review reported the incidence of urinary tract infection associated with catheterization. 28,30,40,61,63,64,66,69,73,75,76,89,100 Six of these reported no infections while seven studies reported rates of \ 10%.…”

Section: Comparison With Other Anesthetic Modalitiesmentioning

confidence: 99%

Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review

Choi

Mahon

Awad

2012

Can J Anesth/J Can Anesth

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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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Section: Comparison With Other Anesthetic Modalitiesmentioning

confidence: 99%

Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review

Choi

Mahon

Awad

2012

Can J Anesth/J Can Anesth

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“…It could also be because of blockade of thinly myelinated fibres, which carry afferents from bladder and ureter. [16] However, the fact that propofol was necessary for these 5 patients during ureteric catheterisation, means that standalone SEA is not useful and supplemental GA is required. Even though prone position was given in these patients only when Ramsay Sedation Score of 2 was achieved, there is a chance of change in sedation levels which could jeopardise positioning, haemodynamics and airway.…”

Section: Discussionmentioning

confidence: 99%

Is segmental epidural anaesthesia an optimal technique for patients undergoing percutaneous nephrolithotomy?

et al. 2017

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Background and Aims:Neuraxial anaesthesia has recently become popular for percutaneous nephrolithotomy (PCNL). We conducted a study comparing general anaesthesia (GA) with segmental (T6–T12) epidural anaesthesia (SEA) for PCNL with respect to anaesthesia and surgical characteristics.Methods:Ninety American Society of Anesthesiologists Physical Status-I and II patients undergoing PCNL randomly received either GA or SEA. Overall patient satisfaction was the primary end point. Intraoperative haemodynamics, epidural block characteristics, post-operative pain, time to rescue analgesic, total analgesic consumption, discharge times from post-anaesthesia care unit, surgeon satisfaction scores and stone clearance were secondary end points. Parametric data were analysed by Student's t-test while non-parametric data were compared with Mann–Whitney U-test.Results:Group SEA reported better patient satisfaction (P = 0.005). Patients in group GA had significantly higher heart rates (P = 0.0001) and comparable mean arterial pressures (P = 0.24). Postoperatively, time to first rescue analgesic and total tramadol consumption was higher in Group GA (P = 0.001). Group SEA had lower pain scores (P = 0.001). Time to reach Aldrete's score of 9 was shorter in group SEA (P = 0.0001). The incidence of nausea was higher in group GA (P = 0.001); vomiting rates were comparable (P = 0.15). One patient in group SEA developed bradycardia which was successfully treated. Eight patients (18%) had hypertensive episodes in group GA versus none in group SEA (P = 0.0001). One patient in GA group had pleural injury and was managed with intercostal drain. Stone clearance and post-operative haemoglobin levels were comparable in both groups.Conclusion:PCNL under SEA has a role in selected patients, for short duration surgery and in expert hands.

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“…In our previous studies, we observed, against our expectations, that during TEA with bupivacaine, fentanyl, and epinephrine, the detrusor was significantly inhibited; this resulted in clinically relevant postvoid residuals (PVRs), which required monitoring or catheterization. 6,7 Because the studies adopted a before and after design with no control group, we could not definitively identify the mechanisms responsible for lower urinary tract dysfunction.…”

Section: Perioperative Medicinementioning

confidence: 99%

Influence of Epidural Mixture and Surgery on Bladder Function after Open Renal Surgery

et al. 2013

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Detrusor Activity Is Impaired during Thoracic Epidural Analgesia after Open Renal Surgery

Abstract: In contrast to our initial hypothesis, detrusor activity was significantly impaired during TEA after open renal surgery. This resulted in clinically relevant postvoid residuals.

Cited by 17 publications

References 37 publications

Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review

Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review

Is segmental epidural anaesthesia an optimal technique for patients undergoing percutaneous nephrolithotomy?

Influence of Epidural Mixture and Surgery on Bladder Function after Open Renal Surgery

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