title: Incidence of urinary retention in patients with thoracic patient-controlled epidural analgesia (TPCEA) undergoing thoracotomy.
abstract: Up to 100% of patients treated with epidural analgesia can experience urinary retention, which may be related to dermatomal level of the epidural block, epidural medication, and surgical procedure. This study was designed to identify the incidence of urinary retention in patients who receive thoracic patient-controlled epidural analgesia (TPCEA) after thoracotomy. Forty-nine patients were enrolled and received epidural infusion of ropivacaine 0.2% or mixture of bupivacaine 0.1% with hydromorphone 0.015 mg/mL. Epidural catheter placement level was verified by chest X-rays. Indwelling urinary catheters were removed between 12 and 48 h after surgery when no longer required for fluid monitoring. Four hours later, patients were assessed for urinary retention using bladder ultrasound. Residual bladder volume was recorded, and urinary retention was defined as an inability to void or a bladder volume of greater than 600 mL at 4 h. Twenty-four hours after the catheter removal, patients completed a questionnaire to assess their perception of the indwelling catheter before and after its removal. Five participants (approximately 10%) with epidural catheters between T3 and T5 with bupivacaine/hydromorphone epidural solution were recatheterized. No association was established between catheter level, drug type, infusion rate, and urinary retention. Although 76% of patients did not report any physical discomfort with the indwelling urinary catheter, 66% felt relief after its removal and 18% did not ambulate with the inserted urinary catheter. The incidence of postoperative urine retention was low (10%), indicating that unless required for other purposes, indwelling urinary catheters may be removed between 12 and 48 h after surgery while receiving TPCEA.
authors.affiliation: Acute Pain Service, Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 3 Eaton North, Toronto, Ontario M5G2C4, Canada. salima.ladak@uhn.on.ca
authors.forename: Salima S J
authors.initials: SS
authors.lastname: Ladak
authors.forename: Rita
authors.initials: R
authors.lastname: Katznelson
authors.forename: Meredith
authors.initials: M
authors.lastname: Muscat
authors.forename: Monakshi
authors.initials: M
authors.lastname: Sawhney
authors.forename: William Scott
authors.initials: WS
authors.lastname: Beattie
authors.forename: Gerald
authors.initials: G
authors.lastname: O'Leary
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000523:psychology; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000523:psychology; D000704:Analysis of Variance; D001294:Attitude to Health; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015404:Nursing Methodology Research; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D014463:Ultrasonography; D014546:Urinary Catheterization / Q000009:adverse effects / Q000523:psychology; D016055:Urinary Retention / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control