Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Department of Anesthesiology, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Dig Surg. 2019;36(3):261-265. doi: 10.1159/000490199. Epub 2018 Jun 26.
BACKGROUND/AIMS: Postoperative urinary retention (POUR) is one of the most frequent complications of epidural anesthesia. This study aims to clarify risk factors of POUR and to estimate the appropriate timing of urethral catheter removal.
Between September and December 2014, a retrospective cohort study was conducted on 120 patients who underwent epidural anesthesia and major abdominal surgery. To observe trends in incidence of POUR, we analyzed the order and interval of removal of epidural and urethral catheters using Cochran-Armitage trend test.
In this study, 40 patients were diagnosed with POUR (33.3%). Median removal of epidural catheters was 4 postoperative days in the POUR group and 3.5 postoperative days in the non-POUR group (p = 0.04). When the urethral catheter was removed before epidural catheter, incidence of POUR was comparatively greater (p < 0.001). There were no statistical differences in surgical fields, operation approach, epidural catheter levels, or epidural opioid use. No patients had urinary tract infections.
We demonstrated that removal of urethral catheter before epidural catheter contributed to increasing trends in incidence of POUR. The optimal order and interval of removal of epidural and urethral catheters should be considered to avoid POUR after abdominal surgery.
背景/目的：术后尿潴留（POUR）是硬膜外麻醉最常见的并发症之一。本研究旨在阐明 POUR 的危险因素，并评估尿道导管拔除的合适时机。
2014 年 9 月至 12 月，对 120 例行硬膜外麻醉和大腹部手术的患者进行回顾性队列研究。为了观察 POUR 发生率的趋势，我们使用 Cochran-Armitage 趋势检验分析了硬膜外和尿道导管的拔除顺序和间隔。
本研究中，40 例患者被诊断为 POUR（33.3%）。POUR 组硬膜外导管拔除的中位数为术后 4 天，非 POUR 组为术后 3.5 天（p=0.04）。当尿道导管在硬膜外导管之前拔除时，POUR 的发生率较高（p<0.001）。手术部位、手术入路、硬膜外导管水平或硬膜外阿片类药物使用无统计学差异。无患者发生尿路感染。
我们表明，尿道导管在硬膜外导管之前拔除会增加 POUR 的发生率。在腹部手术后，应考虑硬膜外和尿道导管的最佳拔除顺序和间隔，以避免 POUR。
