Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department Anesthesia, Intensive Care and Pain Medicine, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Isr Med Assoc J. 2024 Aug;26(7):415-420.
Cesarean deliveries (CD) are commonly performed using neuraxial anesthesia. The use of neuraxial morphine has proven beneficial in terms of postoperative pain management; however, its effect on postoperative urine retention remains unclear.
To determine whether morphine injection into the neuraxis during CD influences postoperative urinary retention rate.
We conducted a retrospective case-control observational study of patients undergoing CD. We compared patients using morphine injected into the intrathecal or epidural spaces (November 2020 to October 2021) to a historical cohort of patients undergoing CD without morphine (November 2019 to October 2020). The primary outcome was the rate of postoperative overt urinary retention necessitating bladder catheterization.
The study group comprised 283 patients, and 313 patients in the control group were eligible for analysis. No differences were found with respect to the baseline demographic and indication for CD. The number of postpartum urinary bladder catheterizations due to urine retention was higher in the study group (5% vs. 1%, P-value = 0.003). No cases of 30-day readmission were recorded. Moreover, patients treated with neuraxial morphine required fewer repeat doses of postoperative anesthesia (oral analgesia 7.4 vs. 10.1, intravenous analgesia 0.29 vs. 0.31, oral opioids 0.06 vs. 3.70, intravenous opioids 0.01 vs. 0.45, P-value < 0.001 for all).
While neuraxial morphine used during CD appears to be safe and effective, the risk of postoperative urinary retention seems to be increased due to its use. Cases of overt urinary retention treated by bladder catheterization does not lead to short-term complications.
剖宫产术通常采用椎管内麻醉。椎管内注射吗啡在术后疼痛管理方面已被证明是有益的；然而，其对术后尿潴留的影响仍不清楚。
确定剖宫产术中在椎管内注射吗啡是否会影响术后尿潴留的发生率。
我们对行剖宫产术的患者进行了回顾性病例对照观察性研究。我们将使用吗啡注入蛛网膜下腔或硬膜外腔的患者（2020 年 11 月至 2021 年 10 月）与未使用吗啡行剖宫产术的历史队列患者（2019 年 11 月至 2020 年 10 月）进行比较。主要结局是术后显性尿潴留需要导尿的发生率。
研究组纳入 283 例患者，对照组中有 313 例患者符合分析条件。两组患者的基线人口统计学特征和剖宫产指征无差异。研究组因尿潴留行产后膀胱导尿术的人数较多（5% vs. 1%，P 值=0.003）。未记录 30 天内再入院的病例。此外，接受椎管内吗啡治疗的患者需要重复使用术后麻醉的次数更少（口服镇痛剂 7.4 次 vs. 10.1 次，静脉镇痛剂 0.29 次 vs. 0.31 次，口服阿片类药物 0.06 次 vs. 3.70 次，静脉阿片类药物 0.01 次 vs. 0.45 次，所有 P 值均<0.001）。
虽然剖宫产术中使用椎管内吗啡似乎是安全有效的，但由于其使用，术后尿潴留的风险似乎增加。经导尿治疗的显性尿潴留病例并未导致短期并发症。
