Patient-controlled analgesia and urinary retention following lower limb joint replacement: prospective audit and logistic regression analysis

Abstract

We studied a number of factors that may be associated with urinary retention, in particular the method of postoperative analgesia delivery, in 47 men and 69 women undergoing lower limb joint replacements. The following factors were studied: age, gender, height, weight, previous history of urinary retention, presence of symptoms suggestive of urinary tract obstruction, type of anaesthetic (general anaesthetic or spinal anaesthetic), type of postoperative analgesia (intramuscular or patient-controlled analgesia with morphine) and the total dose of morphine given. Urinary retention developed in 18.1% of patients.Stepwise logistic regression analysis was used to identify independent explanators of an increased probability of developing urinary retention. Three factors emerged ± male gender, increasing age and the use of patient-controlled analgesia.

Postoperative urinary retention: evaluation of patients using opioids analgesic

“…The predominance of the male gender in urinary retention is also similar to the reviewed studies (3,7,10) .This predominance can be justified by the fact that the supine position inhibits patients' spontaneous urination, especially in men who underwent orthopedic surgeries, whose time of permanence in bed and dependence on nursing care are higher (6,10) .…”

“…Some studies have demonstrated an association between urinary retention and advanced age (7,10) . Besides other factors, one of these studies described previous history of urinary retention and the presence of symptoms suggestive of urinary tract obstruction, through logistic regression analysis.…”

“…Urinary retention has been reported relatively frequently in studies about the subject (6)(7)(8)(9) . In international medical literature, reports of several studies affirm that the incidence of urinary retention can vary from 3 to 40% (2,(5)(6)(7)(8)(9)(10)(11) .…”

“…In international medical literature, reports of several studies affirm that the incidence of urinary retention can vary from 3 to 40% (2,(5)(6)(7)(8)(9)(10)(11) . In Brazil, there are few studies about the theme, especially involving orthopedic surgeries (3,(12)(13) .…”

“…A recent study performed in a total hip arthroplasty concluded that the male gender, advanced age and the use of patient-controlled analgesia are factors that increase the probability of urinary retention (7) . In the physiology of urinary retention, opioids increase the tonus and range of contractions of the urinary sphincter, but diminish contractions of the urethra, making spontaneous urination difficult (8) .…”