Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
Can J Anaesth. 2012 Jul;59(7):681-703. doi: 10.1007/s12630-012-9717-5. Epub 2012 Apr 26.
Urinary retention requiring catheterization carries the risk of infection. Neuraxial anesthesia causes transient impairment of bladder function ranging from delayed initiation of micturition to frank urinary retention. We undertook a review of the literature to determine the elements of neuraxial anesthesia and analgesia that prolong bladder dysfunction and increase the incidence of urinary retention.
We performed a systematic search of the PubMed, MEDLINE, and EMBASE databases (from January 1980 to January 2011) to identify studies where neuraxial anesthesia and/or analgesia were employed and at least one of the following outcomes was reported: urinary retention, time to micturition, or post void residual. We included randomized controlled trials and observational studies published in the English language and we excluded case reports. The randomized trials were graded according to the Jadad score.
Our search yielded 94 studies, and in 16 of these studies, the authors reported time to micturition after intrathecal anesthesia of varying local anesthetics and doses. Intrathecal injections were performed in 41 of these studies, epidural anesthesia/analgesia was used in 39 studies, and five studies involved both the intrathecal and epidural routes. Meta-analysis was not possible because of the heterogeneity of interventions and reported outcomes. The duration of detrusor dysfunction after intrathecal anesthesia is correlated with local anesthetic dose and potency. The incidence of urinary retention displays a similar trend and is further increased by the presence of neuraxial opioids, particularly long-acting variants. Urinary tract infection secondary to catheterization occurred rarely.
Neuraxial anesthesia/analgesia results in transient detrusor dysfunction. The duration of dysfunction depends on the potency and dose of medication used; however, it does not appear to result in significant morbidity.
需要导尿的尿潴留会增加感染的风险。脊麻会导致膀胱功能暂时受损，表现为从排尿延迟到完全尿潴留。我们对相关文献进行了回顾，以确定延长膀胱功能障碍和增加尿潴留发生率的脊麻和镇痛的相关因素。
我们系统性地检索了 PubMed、MEDLINE 和 EMBASE 数据库（1980 年 1 月至 2011 年 1 月），以确定使用脊麻和/或镇痛，且至少报告以下结果之一的研究：尿潴留、排尿时间或残余尿量。我们纳入了发表在英文期刊上的随机对照试验和观察性研究，排除了病例报告。随机试验按照 Jadad 量表进行分级。
我们的检索结果有 94 项研究，其中 16 项研究报告了不同局麻药和剂量的鞘内麻醉后排尿时间。在这些研究中，41 项研究进行了鞘内注射，39 项研究使用了硬膜外麻醉/镇痛，5 项研究同时涉及鞘内和硬膜外途径。由于干预措施和报告结果的异质性，无法进行荟萃分析。鞘内麻醉后逼尿肌功能障碍的持续时间与局麻药的剂量和效能相关。尿潴留的发生率也呈类似趋势，且使用神经轴索阿片类药物，尤其是长效制剂时，发生率进一步增加。导尿引起的尿路感染很少见。
脊麻/镇痛会导致短暂的逼尿肌功能障碍。功能障碍的持续时间取决于所用药物的效能和剂量；但似乎不会导致明显的发病率。
