DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20180626

POUR after spinal anesthesia in lower limb orthopaedic surgeries-a prospective study

Anuradha Sen, Omeshwar Singh

Abstract


Background: Postoperative urinary retention (POUR) is a common problem with overall rates looking at the entire surgical population quoted between 4% and 6%. POUR has been defined as the inability to void in the presence of a full bladder.

Methods: This was a prospective, single-centre, observational study conducted between June 2015 to December 2016 at a tertiary care centre of Northern India. The study group enrolled 186 patients undergoing various lower limb surgeries under spinal anesthesia.

Results: In the present study, out of 186 patients, 101 patients were male and 85 patients were female. Most of the patients were in the 41-60 years age group (78) followed by 72 patients were in the >61 years age group. 21 patients (11.29%) suffered with post operative urine retention (POUR) in whom catheterization was required, the incidence of POUR in joint replacement surgeries was 20.96% (13/62). In the present study incidence of POUR was more in males (12 patients) as compared to females (9 patients). POUR was more common in the elderly age group.

Conclusions: By carefully identifying patients at risk, adopting appropriate anesthetic techniques and perioperative care principles and accurately monitoring bladder volume by ultrasound, POUR may be prevented and the associated morbidity minimized. Hence it becomes imperative to evaluate the true incidence and consequences of POUR in large prospective clinical studies. Spontaneous micturition should remain a criterion for discharge after spinal anaesthesia.


Keywords


Arthroplasty, Catheterization, Lower limb surgeries, POUR, Spinal anaesthesia

Full Text:

PDF

References


Shadle B, Barbaro C, Waxman K, Connor S, Von Dollen K. Predictors of postoperative urinary retention. Am Surg. 2009;75:922-4.

Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139-57.

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

Waterhouse N, Beaumont AR, Murray K, Staniforth P, Stone MH. Urinary retention after total hip replacement. A prospective study. Bone Joint J. 1987;69(1):64-6.

Oishi CS, Williams VJ, Hanson PB, Schneider JE, Colwell CW Jr, Walker RH. Perioperative bladder management after primary total hip arthroplasty. J Arthroplasty. 1995;10:732-6.

Lingaraj K, Ruben M, Chan YH, Das SD. Identification of risk factors for urinary retention following total knee arthroplasty: A Singapore hospital experience. Singapore Med J. 2007;48:213-6.

O’Riordan JA, Hopkins PM, Ravenscroft A, Stevens JD. Patient-controlled analgesia and urinary retention following lower limb joint replacement: Prospective audit and logistic regression analysis. Eur J Anaesthesiol. 2000;17:431-5.

Zaheer S, Reilly WT, Pemberton JH, Ilstrup D. Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum. 1998;41:696-704.

Ballantyne JC, Kupelnick B, McPeek B, Lau J. Does the evidence support the use of spinal and epidural anesthesia for surgery?, J Clin Anesth. 2005;17:382-91.

Lingaraj K, Ruben M, Chan YH, Das SD. Identification of risk factors for urinary retention following total knee arthroplasty: a Singapore hospital experience. Singapore Medi J. 2007;48(3):213.

Sarasin SM, Walton MJ, Singh HP, Clark DI. Can a urinary tract symptom score predict the development of postoperative urinary retention in patients undergoing lower limb arthroplasty under spinal anaesthesia? A prospective study. Ann R Coll Surg Engl. 2006;88:394-8.

Donovan TL, Gordon RO, Nagel DA. Urinary infections in total hip arthroplasty. Influences of prophylactic cephalosporins and catheterization. J Bone Joint Surgery. American volume. 1976;58(8):1134-7.

Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control Hospital Epidemiology. 2008;29(S1):S22-30.

Ratsch G, Niebergall H , Hauenstein L , Reber A. Spinal anaesthesia in day-case surgery. Optimisation of procedures. Anaesthesist. 2007;56:322-7.

Davis S, Erskine R, James MF. A comparison of spinal and epidural anaesthesia for hip arthroplasty. Canadian J Anaesthesia. 1992;39(6):551-4.

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

Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, et al. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg. 2005;101:592-6.