Volume 47, Issue 4, Pages 173-179 (December 2009)

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ABSTRACT

ABSTRACT + REFS

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Optimal Duration of Urinary Catheterization After Thoracotomy in Patients Under Postoperative Patient-controlled Epidural Analgesia

Received 28 April 2009; received in revised form 17 July 2009; accepted 22 July 2009.

Background

Epidural analgesia is widely used for efficient pain relief after major surgery. However, it may cause urinary retention, leading to delayed removal of bladder catheters with prolonged patient discomfort. Using a specific regimen in patient-controlled epidural analgesia (PCEA), we examined the optimal duration of urinary catheterization in patients undergoing major thoracic surgery.

Methods

Seventy-eight patients scheduled for elective thoracotomy were prospectively randomized into two groups: Group 1, removal of the transurethral catheter on the first postoperative day (n = 38); Group 2, removal of the catheter after discontinuation of PCEA (n = 40). The PCEA regimen was a mixture containing low-dose morphine, bupivacaine and neostigmine and was given for 3 days after surgery in all subjects. Micturition problems, pain scores assessed by the visual analog scale (VAS), and side effects were evaluated during and after PCEA treatment.

Results

The average duration of urinary drainage after surgery was 30.2 ± 5.1 hours and 78.5 ± 7.3 hours in Groups 1 and 2, respectively. After removal of the bladder catheter, no patient in either group required re-catheterization for urinary retention or encountered catheter-related infection. VAS scores were significantly lower in Group 1 at rest and at 24, 36 and 48 hours after cessation of PCEA. VAS scores were significantly higher in Group 2 patients, possibly due to catheter-induced pain related to prolonged catheterization.

Conclusion

Routine continuous bladder catheterization may not necessarily be required after thoracotomy in patients with ongoing continuous thoracic epidural analgesia.

KEY WORDS: analgesia, epidural , analgesia, patient-controlled , thoracotomy , urinary catheterization , urinary retention

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Article Outline

• Abstract

• References

• Copyright

References

1. 1 Popping DM , Elia N , Marret E , Remy C , Tramer MR . Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a metaanalysis . Arch Surg . 2008;143:990–1000 . CrossRef

2. 2 Yegin A , Erdogan A , Kayacan N , Karsli B . Early postoperative pain management after thoracic surgery; preand postoperative versus postoperative epidural analgesia: a randomised study . Eur J Cardiothorac Surg . 2003;24:420–424 . Abstract | Full Text | Full-Text PDF (125 KB) | CrossRef

3. 3 Stenseth R , Sellevold O , Breivik H . Epidural morphine for postoperative pain: experience with 1085 patients . Acta Anaesthesiol Scand . 1985;29:148–156 . MEDLINE | CrossRef

4. 4 Wheeler M , Oderda GM , Ashburn MA , Lipman AG . Adverse events associated with postoperative opioid analgesia: a systematic review . J Pain . 2002;3:159–180 . Full Text | Full-Text PDF (121 KB) | CrossRef

5. 5 Igawa Y , Wyndaele JJ , Nishizawa O . Catheterization: possible complications and their prevention and treatment . Int J Urol . 2008;15:481–485 . CrossRef

6. 6 Singh SK , Wadhwa P , Bapuraj JR , Jha V . Transcatheter embolization of internal pudendal artery pseudoaneurysm following traumatic urethral catheterization . Int Urol Nephrol . 2005;37:93–94 . MEDLINE | CrossRef

7. 7 Basse L , Werner M , Kehlet H . Is urinary drainage necessary during continuous epidural analgesia after colonic resection? . Reg Anesth Pain Med . 2000;25:498–501 . MEDLINE | CrossRef

8. 8 Kim JY, Lee SJ, Koo BN, Noh SH, Kil HK, Kim HS, et al. The effect of epidural sufentanil in ropivacaine on urinary retention in patients undergoing gastrectomy . Br J Anaesth . 2006;97:414–418 . MEDLINE | CrossRef

9. 9 Chia YY , Chang TH , Liu K , Chang HC , Ko NH , Wang YM . The efficacy of thoracic epidural neostigmine infusion after thoracotomy . Anesth Analg . 2006;102:201–208 . CrossRef

10. 10 Tammela T , Kontturi M , Lukkarinen O . Postoperative urinary retention. I. Incidence and predisposing factors . Scand J Urol Nephrol . 1986;20:197–201 . MEDLINE | CrossRef

11. 11 Tammela T , Kontturi M , Lukkarinen O . Postoperative urinary retention. II. Micturition problems after the first catheterization . Scand J Urol Nephrol . 1986;20:257–260 . MEDLINE | CrossRef

12. 12 Lanz E , Theiss D , Riess W , Sommer U . Epidural morphine for postoperative analgesia: a double-blind study . Anesth Analg . 1982;61:236–240 . MEDLINE

13. 13 Gerig HJ , Kern F . Postoperative analgesia with epidural morphine after hip operations . Anaesthesist . 1982;31:87–89 [In German] . MEDLINE

14. 14 Bromage PR , Camporesi EM , Durant PA , Nielsen CH . Nonrespiratory side effects of epidural morphine . Anesth Analg . 1982;61:490–495 . MEDLINE

15. 15 Rawal N , Mollefors K , Axelsson K , Lingardh G , Widman B . An experimental study of urodynamic effects of epidural morphine and of naloxone reversal . Anesth Analg . 1983;62:641–647 . MEDLINE

16. 16 Kuipers PW, Kamphuis ET, van Venrooij GE, van Roy JP, Ionescu TI, Knape JT, et al. Intrathecal opioids and lower urinary tract function: a urodynamic evaluation . Anesthesiology . 2004;100:1497–1503 . MEDLINE | CrossRef

17. 17 Wulf H . Epidural analgesia in postoperative pain therapy. A review . Anaesthesist . 1998;47:501–510 [In German] . MEDLINE | CrossRef

18. 18 Platt R , Polk BF , Murdock B , Rosner B . Mortality associated with nosocomial urinary-tract infection . N Engl J Med . 1982;307:637–642 . MEDLINE | CrossRef

19. 19 Benoist S , Panis Y , Denet C , Mauvais F , Mariani P , Valleur P . Optimal duration of urinary drainage after rectal resection. A randomized controlled trial . Surgery . 1999;125:135–141 . Abstract | Full Text | Full-Text PDF (174 KB) | CrossRef

20. 20 Yaksh TL , Grafe MR , Malkmus S , Rathbun ML , Eisenach JC . Studies on the safety of chronically administered intrathecal neostigmine methylsulfate in rats and dogs . Anesthesiology . 1995;82:412–427 . MEDLINE | CrossRef

21. 21 Hood DD , Eisenach JC , Tuttle R . Phase I safety assessment of intrathecal neostigmine in humans . Anesthesiology . 1995;82:331–343 . MEDLINE | CrossRef

22. 22 Klamt JG , Dos Reis MP , Neto JB , Prado WA . Analgesic effect of subarachnoid neostigmine in two patients with cancer pain . Pain . 1996;66:389–391 . Abstract | Full Text | Full-Text PDF (766 KB) | CrossRef

23. 23 Lauretti GR , Reis MP , Prado WA , Klamt JG . Dose-response study of intrathecal morphine versus intrathecal neostigmine, their combination, or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty . Anesth Analg . 1996;82:1182–1187 . MEDLINE | CrossRef

24. 24 Roelants F . The use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics . Curr Opin Anaesthesiol . 2006;19:233–237 . MEDLINE | CrossRef

25. 25 Nakayama M , Ichinose H , Nakabayashi K , Satoh O , Yamamoto S , Namiki A . Analgesic effect of epidural neostigmine after abdominal hysterectomy . J Clin Anesth . 2001;13:86–89 . Abstract | Full Text | Full-Text PDF (200 KB) | CrossRef

26. 26 Omais M , Lauretti GR , Paccola CAJ . Epidural morphine and neostigmine for postoperative analgesia after orthopedic surgery . Anesth Analg . 2002;95:1698–1701 . MEDLINE | CrossRef

27. 27 Van de Velde M, Berends N, Kumar A, Devroe S, Devlieger R, Vandermeersch E, et al. Effects of epidural clonidine and neostigmine following intrathecal labour analgesia: a randomised, double-blind, placebo-controlled trial . Int J Obstet Anesth . 2009;18:207–214 . | CrossRef

28. 28 Roelants F , Lavand'homme PM , Mercier-Fuzier V . Epidural administration of neostigmine and clonidine to induce labor analgesia: evaluation of efficacy and local anesthetic-sparing effect . Anesthesiology . 2005;102:1205–1210 . MEDLINE | CrossRef

29. 29 Roelants F , Lavand'homme PM . Epidural neostigmine combined with sufentanil provides balanced and selective analgesia in early labor . Anesthesiology . 2004;101:439–444 . MEDLINE | CrossRef

30. 30 Lauretti GR , de Oliveira R , Reis MP , Juliao MC , Pereira NL . Study of three different doses of epidural neostigmine coadministered with lidocaine for postoperative analgesia . Anesthesiology . 1999;90:1534–1538 . MEDLINE | CrossRef

31. 31 Beilin B , Nemirovsky AY , Zeidel A , Maibord E , Zelman V , Katz RL . Systemic physostigmine increases the antinociceptive effect of spinal morphine . Pain . 1997;70:217–221 . Abstract | Full Text | Full-Text PDF (189 KB) | CrossRef

32. 32 Durant PA , Yaksh TL . Drug effects on urinary bladder tone during spinal morphine-induced inhibition of the micturition reflex in unanesthetized rats . Anesthesiology . 1988;68:325–334 . MEDLINE | CrossRef

a Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.

b Department of Thoracic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.

Corresponding author. Department of Anesthesiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan, R.O.C.

PII: S1875-4597(09)60051-5

doi:10.1016/S1875-4597(09)60051-5

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