POUR after spinal anesthesia in lower limb orthopaedic surgeries-a prospective study

Abstract

Background: Postoperative urinary retention (POUR) is a common problem with overall rates looking at the entire surgical population quoted between 4% and 6%. POUR has been defined as the inability to void in the presence of a full bladder.Methods: This was a prospective, single-centre, observational study conducted between June 2015 to December 2016 at a tertiary care centre of Northern India. The study group enrolled 186 patients undergoing various lower limb surgeries under spinal anesthesia.Results: In the present study, out of 186 patients, 101 patients were male and 85 patients were female. Most of the patients were in the 41-60 years age group (78) followed by 72 patients were in the >61 years age group. 21 patients (11.29%) suffered with post operative urine retention (POUR) in whom catheterization was required, the incidence of POUR in joint replacement surgeries was 20.96% (13/62). In the present study incidence of POUR was more in males (12 patients) as compared to females (9 patients). POUR was more common in the elderly age group.Conclusions: By carefully identifying patients at risk, adopting appropriate anesthetic techniques and perioperative care principles and accurately monitoring bladder volume by ultrasound, POUR may be prevented and the associated morbidity minimized. Hence it becomes imperative to evaluate the true incidence and consequences of POUR in large prospective clinical studies. Spontaneous micturition should remain a criterion for discharge after spinal anaesthesia.

A Nurse-Led Voiding Algorithm for Managing Urinary Retention After General Thoracic Surgery

“…Using a retrospective cohort study design, Kort et al 21 identified a POUR rate of 12.9% after implementing a nurse-led bladder scanning protocol among 638 patients recovering from hip and knee arthroplasty; previous rates in that population ranged from 25% to 40%. Similarly, Sen et al 22 reported a POUR rate of 11.3% among patients undergoing lower-limb orthopedic surgery under spinal anesthesia, in whom bladder ultrasound was used routinely. Our lower POUR rates may be explained by the fact that in all 3 of these studies, some 20,21 or all patients 22 received spinal anesthesia, a known risk factor for POUR.…”

“…Similarly, Sen et al 22 reported a POUR rate of 11.3% among patients undergoing lower-limb orthopedic surgery under spinal anesthesia, in whom bladder ultrasound was used routinely. Our lower POUR rates may be explained by the fact that in all 3 of these studies, some 20,21 or all patients 22 received spinal anesthesia, a known risk factor for POUR. 1 This form of anesthesia was not used in our population.…”

“…1 This form of anesthesia was not used in our population. In addition, bias may have been introduced into the studies that used retrospective medical record review, 21,22 which relies on others to document accurately the occurrence of POUR.…”