Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review

Abstract

Purpose 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. Methods 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. Principal findings 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. Conclusions 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.

Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for Spinal Anesthesia in Patients Undergoing Knee Arthroscopy in an Outpatient Setting

“…However, intravenous fluid regimen has been considered by several authors not to affect voiding times after spinal anesthesia. 31,32 Obviously, the most important factors affecting voiding times and urinary retention are local anesthetic potency and dose. 31 Moreover, our data are in line with the results of studies in which fluid management was standardized and bladder volumes were measured.…”

“…31,32 Obviously, the most important factors affecting voiding times and urinary retention are local anesthetic potency and dose. 31 Moreover, our data are in line with the results of studies in which fluid management was standardized and bladder volumes were measured. 24,25 A third limitation is the use of lower concentrations of local anesthetics, especially for bupivacaine, which were used in our study compared with other clinical trials.…”

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial

“…21 The incidence of retention increases with the use of longer-acting intrathecal local anesthetics and hydrophilic neuraxial opioids. 22,23 Local anesthetics block the parasympathetic innervation of the bladder via both the pelvic nerves (S2-S4), which promote detrusor contraction and bladder neck relaxation, and the pudendal nerves (S2-S4), which innervate the external sphincter of the bladder. The sympathetic innervation of the bladder from the spinal cord (between T10 and L2) is also at least partially blocked; this has an inhibitory effect on detrusor activity and an excitatory effect on the bladder neck.…”

Urinary retention occurring one week after spinal anesthesia: a case of Elsberg syndrome

“…1,2 In the present case, the patient had at least five days of intact urinary function after surgery until the onset of urinary retention. In addition, anal pain, hypoesthesia in the sacral dermatome, and incontinence associated with the urinary retention were also delayed in presentation until the seventh postoperative day.…”