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Is Urinary Drainage Necessary During Continuous Epidural Analgesia After Colonic Resection?
  1. Linda Basse, M.D.,
  2. Mads Werner, M.D., Ph.D. and
  3. Henrik Kehlet, M.D., Ph.D.
  1. From the Department of Surgical Gastroenterology 435 & Acute Pain Service, Department of Anesthesiology, Hvidovre University Hospital, Hvidovre, Denmark.
  1. Reprint requests: Linda Basse, M.D., Department of Surgical Gastroenterology 435, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.

Abstract

Background and Objectives Postoperative urinary retention may occur in between 10% and 60% of patients after major surgery. Continuous lumbar epidural analgesia, in contrast to thoracic epidural analgesia, may inhibit urinary bladder function. Postoperative urinary drainage has been common in patients with continuous epidural analgesia, despite the lack of scientific evidence for its indication after thoracic epidural analgesia. This study describes 100 patients who underwent elective colonic resection with 48 hours of continuous thoracic epidural analgesia and only 24 hours of urinary drainage.

Methods This is a prospective, uncontrolled study with well-defined general anesthesia, postoperative analgesia, and nursing care programs in patients with a planned 2-day hospital stay, urinary catheter removal on the first postoperative morning, and epidural catheter removal on the second postoperative morning. Follow-up in the outpatient clinic was on days 8 and 30.

Results Nine patients needed bladder recatheterization, 8 as a single procedure and 1 patient a second recatheterization with removal on day 7. This patient had urinary infection on day 10 and was readmitted for 5 days because of urosepsis and, subsequently, for cystitis and left-sided epididymitis. Three patients had uncomplicated urinary infection. No patients had urological complaints at 30 days follow-up (95% confidence limit, 0% to 3.6%).

Conclusion The low incidence of urinary retention (9%) and urinary infection (4%) suggests that routine bladder catheterization beyond postoperative day 1 may not be necessary in patients with ongoing continuous low-dose thoracic epidural analgesia.

  • Urinary complication
  • Epidural analgesia
  • Colonic resection

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Footnotes

  • Supported by Apotekerfonden of 1991 and the Danish Research Council (28809).

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