title: Effects of postoperative analgesia on postpartum urinary retention in women undergoing cesarean delivery.
abstract: OBJECTIVE
  Various analgesics and administration methods are used to provide women undergoing cesarean delivery pain relief after surgery. We compared three methods of postoperative analgesia regarding the incidence of postpartum urinary retention (PUR) in primiparous women undergoing elective cesarean delivery.
  
  
  METHODS
  We estimated post-void residual bladder volume after the first postpartum micturition among 150 parturient women. Risk factors stratified for PUR defined by 150-mL post-void residual bladder volume were analyzed. Obstetric parameters and prevalence of lower urinary tract symptoms after surgery were compared among three groups of parturient women given different postoperative analgesia: epidural bolus morphine (EBM), patient-controlled epidural analgesia (PCEA) with ropivacaine-fentanyl, and intramuscular pethidine.
  
  
  RESULTS
  The incidence of PUR was higher in the group given EBM (33.3%) than the groups receiving ropivacaine-fentanyl by PCEA (15%) or intramuscular pethidine (16.7%) (P = 0.038). Eighteen (12%) parturient women needed bladder catheterization to resolve their urinary retention at 1 day postpartum but all achieved spontaneous micturition prior to hospital discharge. The need for catheterization was also increased in the group with EBM (21.7%) in comparison with the other two groups (6.7% and 3.3%, respectively, P = 0.011). At the 3-month follow up, six women (4%) had obstructive voiding problems and seven women (4.7%) had irritating voiding problems. At the 1-year follow up, only one woman in the EBM group had incomplete emptying and another in the PCEA group had urinary incontinence.
  
  
  CONCLUSIONS
  Epidural analgesia with morphine was significantly associated with post-cesarean urinary retention. Nonetheless, it was not detrimental to later urinary function.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan. ccjoliang@cgmh.org.tw
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
authors.forename: Shuenn-Dhy
authors.initials: SD
authors.lastname: Chang
authors.forename: Shu-Yam
authors.initials: SY
authors.lastname: Wong
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Chang
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000698:Analgesia / Q000009:adverse effects* / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007273:Injections, Intramuscular; D007278:Injections, Spinal; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D011446:Prospective Studies; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000209:etiology*; D014554:Urination / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D008614:Meperidine; D005283:Fentanyl