Urinary Retention Following Inguinal Herniorrhaphy: Role of Neuromuscular Blockade Reversal

Morales, Diana J. Valencia; Stewart, Brody R; Heller, Stephanie F.; Šprung, Juraj; Schroeder, D. R.; Ghanem, Omar M.; Weingarten, Toby N.

doi:10.1097/sle.0000000000000962

Cited by 15 publications

(11 citation statements)

References 18 publications

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“…The lower POUR risk observed in the sugammadex group after hysterectomy is consistent with findings from several reports examining the type of neuromuscular blockade-reversal agent and association with POUR after other surgical procedures. Among 181 patients undergoing laparoscopic inguinal herniorrhaphy, the use of sugammadex was associated with more than 80% reduction in POUR frequency compared with the use of neostigmine-glycopyrrolate (2/75 [3%] vs 16/106 [15%], respectively) [ 8 ]. After video-assisted thorascopic procedures for 276 patients, the POUR incidence was 14% with neostigmine-glycopyrrolate as the reversal agent vs 4% with sugammadex [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study

De Lima Laporta Miranda,

Ochs Kinney,

Bakkum-Gamez

et al. 2024

Biomol Biomed

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Postoperative urinary retention (POUR) is a well-known complication after gynecologic surgery. Our objective was to investigate whether the choice of pharmacologic agent for reversing neuromuscular blockade at the end of a hysterectomy is a risk factor for POUR. Among adult patients undergoing hysterectomy with general anesthesia from 2012 to 2017, those who received aminosteroid nondepolarizing neuromuscular agents followed by pharmacologic reversal were identified, and electronic health records were reviewed. The cohort was dichotomized into two groups by reversal agent: 1) sugammadex and 2) neostigmine with glycopyrrolate. The primary outcome, POUR, was defined as unplanned postoperative bladder recatheterization. A propensity-adjusted analysis was performed to investigate the association between POUR and reversal agent by using inverse probability of treatment weighting to adjust for potential confounders. We identified 1,974 patients, of whom 1,586 (80.3%) received neostigmine-glycopyrrolate and 388 (19.7%) received sugammadex for reversal of neuromuscular blockade. The frequency of POUR was 24.8% (393/1,586) after reversal with neostigmine-glycopyrrolate and 18.3% (71/388) with sugammadex. Results from the propensity-adjusted analysis showed that sugammadex was associated with a lower POUR risk than neostigmine-glycopyrrolate (odds ratio 0.53, 95% confidence interval [CI] 0.37 - 0.76, P < 0.001). A post hoc analysis of sugammadex recipients who received glycopyrrolate for another indication showed a higher POUR risk than among those who did not receive glycopyrrolate (odds ratio 1.86, 95% CI 1.07 - 3.22, P = 0.03). Use of sugammadex to reverse aminosteroid neuromuscular blocking agents is associated with decreased risk of POUR after hysterectomy. A potential mechanism is the omission of glycopyrrolate, which is coadministered with neostigmine to mitigate unwanted cholinergic effects.

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Section: Discussionmentioning

confidence: 99%

Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study

De Lima Laporta Miranda,

Ochs Kinney,

Bakkum-Gamez

et al. 2024

Biomol Biomed

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“…In a recent study by Valencia Morales et al ,[ 60 ] a correlation was demonstrated between the use of sugammadex and the lower incidence of POUR in adult patients undergoing hernioplasty under general anesthesia to whom aminosteroid neuromuscular blockers had been administered. The antagonization of residual neuromuscular block was carried out in 106 patients using neostigmine and glycopyrrolate, and in 75 patients using sugammadex.…”

Section: Introductionmentioning

confidence: 99%

“…Especially in older patients, the use of sugammadex seems to have a good correlation with the reduction in the incidence of POUR. [ 17 60 ]…”

Section: Introductionmentioning

confidence: 99%

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Postoperative urinary retention (POUR): A narrative review

Cambise,

De Cicco,

Luca

et al. 2024

Saudi Journal of Anaesthesia

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Postoperative urinary retention (POUR) is defined as the inability to void in the presence of a full bladder after surgery. Complications include delirium, pain, prolonged hospitalization, and long-term altered bladder contractility. Comorbidities, type of surgery and anesthesia influence the development of POUR. The incidence varies between 5% and 70%. History and clinical examination, the need for bladder catheterization and ultrasonographic evaluation are three methods used to diagnose POUR. The prevention of POUR currently involves identifying patients with pre-operative risk factors and then modifying them where possible. Bladder catheterization is the standard treatment of POUR, however, further studies are necessary to establish patients who need a bladder catheter, bladder volume thresholds and duration of catheterization.

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“…1 Therefore, to reduce the incidence of postoperative urinary retention (POUR), sugammadex has previously been used as the reversal agent. [2][3][4] The United States Food and Drug Administration does not recommend the use of sugammadex in patients with renal impairment because of its pharmacokinetic properties. However, a previous study showed that it can be used safely in patients with end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

Effect of glycopyrrolate on the postoperative urine output of patients following kidney transplantation: a retrospective observational study

Koo,

Park,

Jang

et al. 2023

J Int Med Res

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Objectives To compare the urine output and estimated glomerular filtration rate (eGFR) of patients postoperatively administered sugammadex or glycopyrrolate 7 days following kidney transplantation (KT). Methods We retrospectively enrolled 134 consecutive patients who underwent KT under general anesthesia. Their urine output and eGFR were recorded every 24 hours between postoperative day (POD) 1 and 7. We used regression analysis to evaluate the relationship between the reversal agent administered and the outcomes of the participants. Results The urine output and eGFR of the participants did not differ between the two groups. Multivariate analysis showed that body mass index (BMI) (odds ratio (OR) 1.21; 95% confidence interval (CI) 1.05–1.40), diabetes mellitus (OR 3.14; 95% CI 1.07–9.16), neurovascular disease (OR 7.00; 95% CI 1.61–30.42), and the duration of surgery (OR 1.01; 95% CI 1.00–1.01) were associated with lower urine output on POD 7. In addition, only BMI (OR 1.25; 95% CI 1.09–1.42) was associated with low eGFR on POD 7. Conclusions The urine output and eGFR of patients administered sugammadex or glycopyrrolate following KT did not differ 7 days later. Moreover, glycopyrrolate does not affect urine output or eGFR on POD 7, according to multivariate regression analysis.

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Urinary Retention Following Inguinal Herniorrhaphy: Role of Neuromuscular Blockade Reversal

Cited by 15 publications

References 18 publications

Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study

Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study

Postoperative urinary retention (POUR): A narrative review

Effect of glycopyrrolate on the postoperative urine output of patients following kidney transplantation: a retrospective observational study

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