Linares Gil María José, Esteve Gómez Anna, Blanco Vargas Domingo, Martinez Garcia Esther, Daros Francisco Nebot, Tugas Elisenda Izquierdo, Paises Angels Almenar, Pi-Siques Felip
Department of Anesthesiology, Viladecans Hospital, Barcelona, Spain.
Am J Surg. 2009 Feb;197(2):182-8. doi: 10.1016/j.amjsurg.2007.12.064. Epub 2008 Aug 23.
Spinal anesthesia has been considered inappropriate for ambulatory surgery patients because of concern about voiding dysfunction. The purpose of this study was to analyze the relationship between voiding interval and type of surgery under spinal anesthesia with lidocaine and to identify other nonanesthetic risk factors for delayed voiding.
A prospective study of 406 patients undergoing to ambulatory surgery under spinal anesthesia with lidocaine was performed. Voiding interval was defined as the time in minutes from the injection of local anesthetic to the patient's first spontaneous voiding. Univariate and multivariate linear regression models were constructed to identify risk factors associated with length of voiding interval.
A total of 187 patients underwent herniorrhaphy; 187 patients underwent lower limb surgery; and 32 patients went benign anorectal surgery. The mean +/- sd voiding interval was 230 +/- 50.5 minutes. Factors associated with length of voiding interval in the univariate analysis were sex, body mass index (BMI), type and duration of surgery, lidocaine dose, and volume of fluid administered. Factors that remained significant in the multivariate model were sex, BMI, lidocaine dose and type of surgery: spontaneous voiding came later after inguinal herniorrhaphy surgery than after lower-limb surgery (regression coefficient 20 minutes; 95% confidence interval 11.5-29.8). Multivariate models performed for each type of surgery separately identified sex and lidocaine dose as factors related to length of voiding interval in all types of surgery.
A longer voiding interval was associated with inguinal herniorrhaphy, spinal lidocaine dose, and male sex.
由于担心排尿功能障碍，脊髓麻醉一直被认为不适用于门诊手术患者。本研究的目的是分析利多卡因脊髓麻醉下排尿间隔与手术类型之间的关系，并确定导致排尿延迟的其他非麻醉性危险因素。
对406例行利多卡因脊髓麻醉的门诊手术患者进行了一项前瞻性研究。排尿间隔定义为从注射局部麻醉剂到患者首次自主排尿的时间（以分钟为单位）。构建单变量和多变量线性回归模型以确定与排尿间隔时间相关的危险因素。
共有187例患者接受了疝修补术；187例患者接受了下肢手术；32例患者接受了良性肛肠手术。平均排尿间隔时间为230±50.5分钟。单变量分析中与排尿间隔时间相关的因素包括性别、体重指数（BMI）、手术类型和持续时间、利多卡因剂量以及输液量。多变量模型中仍具有显著意义的因素为性别、BMI、利多卡因剂量和手术类型：腹股沟疝修补术后自主排尿时间比下肢手术后晚（回归系数20分钟；95%置信区间11.5 - 29.8）。对每种手术类型分别进行的多变量模型分析确定，性别和利多卡因剂量是所有手术类型中与排尿间隔时间相关的因素。
较长的排尿间隔与腹股沟疝修补术、脊髓利多卡因剂量以及男性性别有关。
