Senapathi Tjokorda Gde Agung, Wiryana Made, Subagiartha I Made, Suarjaya I Putu Pramana, Widnyana I Made Gede, Sutawan Ida Bagus Krisna Jaya, Jaya A A Gde Putra Semara, Thewidya Andri
Department of Anesthesiology and Intensive Care, Sanglah Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia,
Ther Clin Risk Manag. 2018 Sep 11;14:1685-1689. doi: 10.2147/TCRM.S176281. eCollection 2018.
Postoperative urinary retention (POUR) is one of the most common complications following spinal anesthesia. Spinal anesthesia may influence urinary bladder function due to interruption of the micturition reflex. Urinary catheterization is the standard treatment of POUR. Urinary catheter insertion is an invasive procedure, which is associated with catheter-related infections, urethral trauma, and patient discomfort. The purpose of this study was to determine the effectiveness of intramuscular (IM) neostigmine to accelerate bladder emptying after spinal anesthesia.
A total of 36 patients undergoing lower abdominal (except for pelvic, urologic, anorectal, and hernia surgery) and lower extremity surgery under spinal anesthesia were divided into two groups randomly (n=18), to either neostigmine (N) group or control (C) group. Neostigmine 0.5 mg (N group) or NaCl 0.9% (C group) was administered intramuscularly when Bromage score 0 and sensory level sacral two have been achieved. The time to first voiding after IM injection and the time to first voiding after spinal anesthesia were measured.
The time to first voiding after IM injection was significantly faster (≤0.05) in the N group than that in the C group, with median time as 40 minutes (20-70 minutes) and 75 minutes (55-135 minutes), respectively. Time to first voiding after spinal anesthesia was also significantly faster (≤0.05) in the N group than that in the C group (mean of 280.8±66.6 minutes and 364.2±77.3 minutes, respectively).
IM neostigmine effectively accelerates bladder emptying after spinal anesthesia.
术后尿潴留（POUR）是脊髓麻醉后最常见的并发症之一。脊髓麻醉可能因排尿反射中断而影响膀胱功能。导尿是POUR的标准治疗方法。插入导尿管是一种侵入性操作，与导管相关感染、尿道创伤及患者不适有关。本研究的目的是确定肌内注射新斯的明加速脊髓麻醉后膀胱排空的有效性。
总共36例在脊髓麻醉下接受下腹部（盆腔、泌尿外科、肛肠和疝气手术除外）及下肢手术的患者被随机分为两组（n = 18），即新斯的明（N）组和对照组（C）组。当布罗玛杰评分达到0且感觉平面达到骶二时，肌内注射0.5 mg新斯的明（N组）或0.9%氯化钠（C组）。测量肌内注射后首次排尿时间及脊髓麻醉后首次排尿时间。
N组肌内注射后首次排尿时间明显快于C组（≤0.05），中位时间分别为40分钟（20 - 70分钟）和75分钟（55 - 135分钟）。N组脊髓麻醉后首次排尿时间也明显快于C组（≤0.05）（分别为280.8±66.6分钟和364.2±77.3分钟）。
肌内注射新斯的明可有效加速脊髓麻醉后膀胱排空。
