title: The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty.
abstract: BACKGROUND
  Postoperative urinary retention requiring urethral catheterisation increases the risk of joint sepsis following arthroplasty. Spinal anaesthesia with opiate administration is used widely in lower limb arthroplasty. We sought to establish whether the choice of opiate agent had any effect on the incidence of postoperative retention and therefore the risk of joint sepsis.
  
  
  METHODS
  A total of 445 consecutive patients who underwent primary elective lower limb arthroplasty were reviewed retrospectively. Patients had general anaesthesia and femoral nerve block (GA+FNB), spinal anaesthesia and intrathecal fentanyl (SA+ITF) or spinal anaesthesia and intrathecal morphine (SA+ITM).
  
  
  RESULTS
  Urinary retention was observed in 14% of male and 2% of female patients with GA+FNB, 9% of male and 3% of female patients with SA+ITF, and 60% of male (p=0.0005) and 5% of female patients with SA+ITM. Men who experienced retention were older (68 vs 64 years, p=0.013) and had longer inpatient stays (6.7 vs 4.6 days, p=0.043). Fewer patients in the SA+ITM group required breakthrough analgesia (28% vs 58%, p=0.004). Concusions: The use of ITM in men significantly increases the incidence of urinary retention requiring urethral catheterisation and subsequently increases the risk of deep joint sepsis. Its use should be rationalised against the intended benefits and alternatives sought where possible.
authors.affiliation: University Hospitals Coventry and Warwickshire NHS Trust, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Fernandez
authors.forename: S
authors.initials: S
authors.lastname: Karthikeyan
authors.forename: M
authors.initials: M
authors.lastname: Wyse
authors.forename: P
authors.initials: P
authors.lastname: Foguet
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects; D009407:Nerve Block / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl