Effects of dexamethasone on postoperative urinary retention after laparoscopic inguinal hernia repair

Denham, Merritt; Donovan, Kara; Wetoska, Nicole M.; Kuchta, Kristine; Carbray, JoAnn; Linn, John G.; Denham, Woody; Joehl, Raymond J.; Ujiki, Michael

doi:10.1007/s00464-018-6572-7

“…Because perioperative steroids can affect the incidence of POUR following inguinal hernia repair, 12 we conducted a post hoc analysis to assess if dexamethasone was associated with the incidence of POUR. However, in this cohort, no association was found.…”

Section: Discussionmentioning

confidence: 99%

“…Since opioid administration in the PACU was found to differ significantly between groups, an additional IPTW analysis was performed which further adjusted for PACU opioid administration by including this variable as a covariate. Because perioperative steroids may affect the incidence of POUR, 12 a post hoc analysis was conducted to assess if this outcome was associated with the perioperative administration of dexamethasone, a standard antiemetic medication used in our practice. In all cases, 2-tailed P < 0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Urinary Retention Following Inguinal Herniorrhaphy: Role of Neuromuscular Blockade Reversal

Morales¹,

Stewart²,

Heller³

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Nondepolarizing neuromuscular blockade is reversed with neostigmine/glycopyrrolate or sugammadex. Anticholinergic glycopyrrolate decreases bladder detrusor muscle contractility, potentially leading to postoperative urinary retention (POUR). POUR commonly complicates inguinal herniorrhaphy. In this study we assess association between reversal technique and POUR.Methods: Records of adult patients undergoing unilateral inguinal herniorrhaphy with neuromuscular blockade from January 2013 to September 2020 were reviewed for POUR (unplanned postoperative insertion of urinary catheter). A propensity-adjusted analysis was performed to assess POUR in neostigmine/glycopyrrolate versus sugammadex using inverse probability of treatment weighting (IPTW) to adjust for potential confounding.Results: We identified 181 patients who underwent herniorrhaphy with amnio-steroidal neuromuscular blockers, 75 (41.4%) who received sugammadex and 106 (58.6%) neostigmine/glycopyrrolate. Compared with sugammadex, neostigmine/glycopyrrolate group had longer surgical course [unweighted standardized difference (USTD) = 0.38, P = 0.004], received more intraoperative opioids (USTD = 0.704, P < 0.001), more often performed via laparoscopic approach (USTD = 0.407, P = 0.012), and less often with periprocedural urinary catheter insertion (USTD = 0.452, P = 0.003). POUR was observed in 2 (3%) of patients in the sugammadex group, and 16 (15%) in neostigmine/glycopyrrolate [unadjusted odds ratio (OR) = 0.15; 95% confidence interval (CI): 0.03-0.69; P = 0.015, and IPTW OR = 0.13; 95% CI: 0.03-0.64; P = 0.012]. Results remained similar with further analysis adjusted for opioid administration in the postanesthesia care unit (adjusted IPTW OR = 0.18; 95% CI: 0.04-0.88; P = 0.034). Of the POUR patients, 9 required unplanned overnight admission and 4 emergency room visit. Conclusion:These results suggest that neuromuscular blockade reversal with sugammadex is associated with lower rates of POUR following unilateral inguinal herniorrhaphy. Our results need to be reconfirmed in a randomized prospective study.

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“…Other measures contributing to reduced opioid use were ultrasound-guided transversus abdominis plane blocks [24] and systemic lidocaine [25]. Finally, 8 mg of dexamethasone just before the start of the procedure has been proven to reduce AUR after laparoscopic inguinal hernia repair [26]; therefore, its possible benefit for colorectal surgery should be investigated.…”

Section: Discussionmentioning

confidence: 99%

Systematic Early Urinary Catheter Removal Integrated in the Full Enhanced Recovery After Surgery (ERAS) Protocol After Laparoscopic Mid to Lower Rectal Cancer Excision: A Feasibility Study

Meillat

¹

,

Magallon

²

,

Brun

³

et al. 2021

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Purpose: Enhanced Recovery After Surgery (ERAS) programs advocate early urinary catheter removal after rectal cancer surgery; however, the optimal duration remains unclear. This study assessed the feasibility of the early urinary catheter removal protocol after rectal cancer surgery within an ERAS pathway and identified predictive factors for failure of this strategy.Methods: Between March 2017 and October 2018, all unselected and consecutive patients who underwent rectal cancer resection and benefited from our ERAS program were included. Urinary complications (infection and retention) were prospectively recorded. Success was defined as catheter removal on postoperative day (POD) 3 without urinary complications.Results: Of 135 patients (male, 63.7%; neoadjuvant chemoradiation, 57.0%; urology history, 17.8%), 120 had early urinary catheter removal with no complications (success rate, 88.9%), 8 did not have urinary catheter removal on POD 3 due to clinical judgment or prescription error, 5 experienced a urinary tract infection, and 2 had acute urinary retention. Obesity (odds ratio [OR], 0.16; P = 0.003), American Society of Anesthesiologists physical status classification > II (OR, 0.28; P = 0.048), antiaggregant platelet medication (OR, 0.12; P < 0.001), absence of anastomosis (OR, 0.1; P = 0.003), and prolonged operative time (OR, 0.21; P = 0.020) were predictive factors for failure. Conversely, optimal compliance with the ERAS program (OR, 7.68; P < 0.001), postoperative nonsteroidal anti-inflammatory drug use (OR, 21.71; P < 0.001), and balanced intravenous fluid therapy (OR, 7.87; P = 0.001) were associated with increased strategy success.Conclusion: Withdrawal of the urinary catheter on POD 3 was successfully achieved after laparoscopic rectal resection and can be safely implemented in the ERAS program.

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“…Surgical resection is often used clinically, which has better therapeutic effect. However, because of the large trauma area of the surgery and intraoperative free ureter lower end, the peripheral nerve of the bladder may be removed when upper pushing the bladder, thereby causing postoperative bladder dysfunction and then the occurrence of urinary retention [ 17 ]. In addition, because of the mental stress caused by postoperative pain, being unaccustomed to urinating in bed, and urinary tract infection caused by urinary catheter insertion, the possibility of urinary retention will also increase, which may result in pyelitis, obstruction of the ureter, ureteral fistula, and other complications, affecting the postoperative recovery.…”

Section: Discussionmentioning

confidence: 99%

Effect Observation on Modified Zishen Tongguan Decoction Combined with Acupuncture in Treatment of Urinary Retention after Cervical Cancer Surgery and Its Influence on the Incidence of Adverse Reactions

Wang

¹

,

Wang

²

,

Zhang

³

2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the effect observation on modified Zishen Tongguan decoction combined with acupuncture in the treatment of urinary retention after cervical cancer surgery and its influence on the incidence of adverse reactions. Methods. The clinical data of 84 patients suffered from urinary retention after radical resection of cervical cancer (December 2018–December 2019) in the oncology department of Jinan Municipal Hospital of Traditional Chinese Medicine were selected for retrospective analysis. According to the order of admission, they were divided into group A (n = 42), treated with conventional therapy, modified Zishen Tongguan decoction, and acupuncture, and group B (n = 42), treated with conventional therapy. The clinical efficacy of the two groups was observed, the urination function indexes after therapy were recorded, and the clinical efficacy and incidence of adverse reactions were analyzed. Results. After therapy, compared with group B, the average urinary flow rate, maximum urinary flow rate, bladder compliance (BC) level value, and the number of patients with good recovery of bladder function of group A were obviously higher P < 0.05 , and the urination time and detrusor pressure were obviously lower P < 0.001 . There was no significant difference in the average scoring of overactive bladder syndrome score (OABSS) between the two groups at 7 days of therapy p > 0.05 . The average OABSS of group A at 14 days of therapy was obviously lower than that of group B P < 0.001 . Compared with group B, the total clinical effective rate of group A was obviously higher P < 0.05 , while the total incidence of adverse reactions was obviously lower P < 0.05 . Conclusion. Modified Zishen Tongguan decoction combined with acupuncture is a reliable method to treat urinary retention after cervical cancer surgery, which greatly improves the urination function of patients, as well as the clinical efficacy. Further research will help create a better solution for patients with urinary retention after cervical cancer surgery.

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Effects of dexamethasone on postoperative urinary retention after laparoscopic inguinal hernia repair

Cited by 8 publications

References 21 publications

Urinary Retention Following Inguinal Herniorrhaphy: Role of Neuromuscular Blockade Reversal

Urinary Retention Following Inguinal Herniorrhaphy: Role of Neuromuscular Blockade Reversal

Systematic Early Urinary Catheter Removal Integrated in the Full Enhanced Recovery After Surgery (ERAS) Protocol After Laparoscopic Mid to Lower Rectal Cancer Excision: A Feasibility Study

Effect Observation on Modified Zishen Tongguan Decoction Combined with Acupuncture in Treatment of Urinary Retention after Cervical Cancer Surgery and Its Influence on the Incidence of Adverse Reactions

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