Postoperative urinary retention after general and spinal anesthesia in orthopedic surgical patients

Abstract

Background: After general, spinal anesthesia and surgery, urinary retention is common. The aim of the study was to compare the effect of general anesthesia versus spinal anesthesia on postoperative urinary retention Patients and methods: After obtaining local ethics committee approval and written consent, 60 male patients, aged 16-40 years, ASA -physical status I and II were divided into two groups (S) 40 patients and (G) 20 patients undergoing surgery of the lower limb lasting up to 90 min (knee arthroscopy, internal tibial fixation with plate and screws). Group (S) was taken spinal anesthesia, this group was divided into two groups (S 1 ) 20 patients, who were taken plain bupivacaine and group (S 2 ) 20 patients who were taken plain bupivacaine plus fentanyl. Group (G) 20 patients were anesthetized by general anesthesia. Results: There were statistically significant differences among groups S1, S2 and G regarding spontaneous micturition, residual volume and time since spinal or general anesthesia till micturition. The percent numbers of patients with retention were 20% in group S1, 35% in group S2 and 8% in group G. Conclusion: Urinary retention is more common after spinal than general anesthesia in orthopedic patients. Adding narcotics to the local anesthetics intrathecally causes more incidence of postoperative urinary retention, which may delay patients discharge and transabdominal ultrasonography is a reliable, noninvasive, inexpensive and simple method to measure bladder volume postoperatively.

Incidence of urinary retention and relations between patient's complaint, physical examination, and bladder ultrasound

“…This lack of criteria to diagnose UR and, therefore, to indicate BRC, contributes to the great variability in the incidence rates of UR described in the literature. Several studies (7)(8)(9)(18)(19)(20) report incidence rates ranging from 2% to 60%, which is consistent with those we found when assessing incidence in the categories suggested in the literature (< 300mL, from 300 mL to 499 mL, and ≥ 500 mL). However, the incidence rates found in the literature come from studies predominantly conducted with patients in the immediate postoperative period or admitted to post-surgical units.…”

“…The literature on the theme is almost exclusively limited to studies with surgical patients, mainly in the immediate post-anesthesia period. In this context, the incidence of UR ranges from 2% to 60% and is especially related to the type of surgery performed, the type of anesthesia administered, and the use of anticholinergic or analgesic drugs (7)(8)(9) .…”

Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

“…In support of this, the authors of a recent meta-analysis [4] found that the duration of catheterization may influence POUR and stated that a duration of 24-48 hours in those with risk factors for POUR is a reasonable option to reduce its occurrence. Furthermore, the anesthetic type and use of continuous epidural analgesia did not influence POUR, which is similar to prior results [14], but overall controversial [12,15]. Bladder hypotonia is expected to resolve within 8 hours after discontinuation of spinal anesthesia [5], so it is not surprising that no difference in observed urinary retention was observed in our study, which had a minimum of 13.9 hours of urinary catheterization.…”

Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial

“…The risk to be catheterized after hyperbaric bupivacaine and articaine was eight times and three times higher, respectively, as compared to general anesthesia. Available literature comparing general anesthesia with spinal anesthesia and its association with urinary catheterization is limited (Bjerregaard et al, 2015;Fernandez et al, 2014;Niazi & Taha, 2015;Scholten et al, 2018). More specifically, there are no recent studies regarding POUR or urinary catheterization after general anesthesia, let alone comparing their incidence with spinal anesthesia.…”