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Abstract
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Background and Aims Cesarean delivery(CD) is a common procedure with potential complications. Enhanced Recovery After Surgery(ERAS) guidelines recommend immediate removal of urinary catheters after CD. However, there’s limited evidence supporting this practice. Prolonged catheterization increases the risk of urinary tract infections(UTIs) and other complications, while premature removal can lead to urinary retention. Anesthetic type, such as spinal or epidural, may influence urinary retention. This systematic review aims to compare the effect of neuraxial anesthesia on urinary catheter removal after CD, focusing on spinal and epidural anesthesia.
Methods This systematic review follows Cochrane Collaboration and PRISMA guidelines. Eligible studies include randomized controlled trials(RCT), cluster-RCT, controlled non-randomized clinical trials, cluster trials, case reports, observational cohort studies (controlled/uncontrolled), cross-sectional studies, commentary, or letters to editors. A comprehensive search was conducted in PubMed/Ovid Medline, EMBASE, Scopus, and The Cochrane Library databases from July2010-July2022. Data extraction involved study characteristics, anesthetic practices, and outcomes such as catheterization duration, urinary retention, and urinary tract infection.
Results Out of 10,916 papers initially identified, five studies were included in this systematic review (figure 1). Although this review showed that neuraxial anesthesia in CD leads to higher rates of urinary-retention and longer catheterization duration, no direct comparison between spinal and epidural anesthesia was found (table 1). The heterogeneity in study populations, anesthetic methods, and definitions of urinary retention precluded quantitative comparisons.
Study selection process
Summary of included articles from the systematic review
Conclusions This study reveals insufficient studies comparing epidural and spinal anesthesia regarding urinary catheterization duration after CD. Further research is needed to investigate and differentiate the effects of epidural and spinal anesthesia on urinary catheterization duration in this context.