Department of Anaesthesiology and Pain Therapy, University of Bern, Bern, Switzerland.
Neurourol Urodyn. 2011 Jan;30(1):121-5. doi: 10.1002/nau.20950. Epub 2010 Jun 29.
The need for an indwelling transurethral catheter in patients with postoperative thoracic epidural analgesia (TEA) is a matter of controversy. Subjective observations are ambivalent and the literature addressing this issue is scarce. As segmental blockade can be achieved with epidural analgesia, we hypothesized that analgesia within segments T4-T11 has no or minimal influence on lower urinary tract function. Thus, we evaluated the effect of TEA on lower urinary tract function by urodynamic studies.
In 13 women with no preoperative lower urinary tract symptoms undergoing open kidney surgery by lumbotomy under TEA, we prospectively assessed changes in urodynamic parameters the day before and 2-3 days after surgery with the patients under TEA.
Before versus during TEA, there was a significant increase in postvoid residual (median, 5 ml vs. 220 ml, P<0.001) and a significant decrease in maximum detrusor pressure (median, 23 cmH(2) O vs. 5 cmH(2) O, P=0.001), detrusor pressure at maximum flow rate (median, 18 cmH(2) O vs. 5 cmH(2) O, P=0.001), maximum flow rate (median, 12 ml/sec vs. 3 ml/sec, P<0.001), and voided volume (median, 250 ml vs. 40 ml, P<0.001). In addition, maximum urethral closure pressure at rest decreased significantly under TEA from median 75 cmH(2) O to 56 cmH(2) O (P=0.002). Bladder sensation, maximum cystometric capacity, compliance, and functional profile length at rest were not influenced by TEA.
TEA has a significant effect on bladder emptying with clinically relevant postvoid residual (PVR) necessitating (indwelling or intermittent) catheterization or monitoring of PVR.
术后胸段硬膜外镇痛（TEA）患者留置导尿管的必要性存在争议。主观观察结果不一，且相关文献也很少。由于硬膜外镇痛可实现节段性阻滞，我们假设 T4-T11 节段的镇痛对下尿路功能没有影响或影响很小。因此，我们通过尿动力学研究来评估 TEA 对下尿路功能的影响。
13 名女性因开腹肾手术接受 TEA 下经腰部穿刺，无术前下尿路症状，前瞻性评估患者在 TEA 前 1 天和术后 2-3 天的尿动力学参数变化。
与 TEA 前相比，TEA 时的残余尿量显著增加（中位数，5ml 比 220ml，P<0.001），最大逼尿肌压显著降低（中位数，23cmH2O 比 5cmH2O，P=0.001），逼尿肌压力最大流率时显著降低（中位数，18cmH2O 比 5cmH2O，P=0.001），最大流率显著降低（中位数，12ml/sec 比 3ml/sec，P<0.001），排尿量显著减少（中位数，250ml 比 40ml，P<0.001）。此外，TEA 时静息状态下最大尿道闭合压从中位数 75cmH2O 显著降低至 56cmH2O（P=0.002）。膀胱感觉、最大膀胱容量、顺应性和静息状态下的功能轮廓长度不受 TEA 影响。
TEA 对膀胱排空有显著影响，导致临床相关的残余尿量（PVR）需要（留置或间歇性）导尿或监测 PVR。
