Department of Anesthesiology and Pain Therapy, University Hospital Bern, Bern, Switzerland.
Reg Anesth Pain Med. 2011 Jan-Feb;36(1):46-50. doi: 10.1097/AAP.0b013e3182030828.
We found in previous studies that thoracic epidural analgesia (TEA) after open renal surgery via lumbotomy significantly impaired bladder function with decreased detrusor contractility and increased postvoid residuals under urodynamic assessment. Here we evaluated the effect of TEA on bladder emptying in patients undergoing thoracotomy.
In a prospective, follow-up study, 13 men and 13 women with an International Prostate Symptom Score of less than 7 and with a postvoid residual of less than 100 mL underwent sonographic assessment of the postvoid residual the day before thoracotomy without TEA and 2 days postoperatively under TEA. The epidural catheter was inserted at level T4/5 or 5/6. Continuous epidural analgesia was maintained with a mixture of bupivacaine 1 mg/mL, epinephrine 2 μg/mL, and fentanyl 2 μg/mL. Primary outcome was the difference in postvoid residual before versus during TEA.
The postvoid residual did not change significantly preoperatively and postoperatively in men (P = 0.09) and women (P = 0.18). However, a significant decrease in bladder capacity at strong desire to void and voided volumes was observed in women. Of the 3 male patients with an initial International Prostate Symptom Score of 3 or greater and less than 7, all developed a postvoid residual of greater than 100 mL and were older than 50 years.
Most patients after thoracotomy had unchanged postvoid residuals under TEA. Our study design does not allow us to determine cause and effect or to make conclusions that are based on comparative, randomized data. However, our observations do yield a hypothesis-generating basis for future clinical trials.
我们在先前的研究中发现，经腰椎切开的开放式肾脏手术后行胸椎硬膜外镇痛（TEA），会显著降低逼尿肌收缩力，增加尿动力学评估时的残余尿量，从而导致膀胱功能受损。在此，我们评估了 TEA 对剖胸术后患者膀胱排空的影响。
在一项前瞻性随访研究中，13 名男性和 13 名女性患者的国际前列腺症状评分（IPSS）均<7，且残余尿量<100ml，在未行 TEA 的剖胸术前 1 天和 TEA 后 2 天行残余尿量的超声评估。硬膜外导管在 T4/5 或 5/6 水平插入。连续硬膜外镇痛采用布比卡因 1mg/ml、肾上腺素 2μg/ml 和芬太尼 2μg/ml 的混合物维持。主要结局是 TEA 前后残余尿量的差异。
男性（P=0.09）和女性（P=0.18）患者在术前和术后的残余尿量均无显著变化。然而，女性在强烈排尿欲望时的膀胱容量和排空量明显下降。在最初的 IPSS 为 3 或更小但<7 的 3 名男性患者中，所有患者都出现了>100ml 的残余尿量，且均>50 岁。
大多数剖胸术后患者在 TEA 下残余尿量无变化。我们的研究设计不允许我们确定因果关系，也不允许我们根据对照、随机数据得出结论。然而，我们的观察结果确实为未来的临床试验提供了一个产生假说的基础。
