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Lips W, Sie CS, Freeman LM. Urinary retention during and after labor with programmed intermittent epidural bolus (PIEB) analgesia: a prospective observational study. Int J Obstet Anesth 2025; 61:104326. [PMID: 39827663 DOI: 10.1016/j.ijoa.2024.104326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 12/26/2024] [Accepted: 12/31/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND This study investigates the incidence and risk factors for urinary retention during and after labor in women receiving programmed intermittent epidural bolus (PIEB) analgesia and evaluates the optimal bladder management strategy. METHODS This prospective observational study assessed urinary retention during voiding attempts every two to three hours during labor and postpartum, among women with labor epidural analgesia using PIEB. Urinary retention was defined as a post-void residual volume >150 mL, determined by catheterization after spontaneous voiding. RESULTS Among 137 women included, with 277 voiding attempts during labor, the urinary retention rate was 20.6%, occurring in 48 women (35%). When the spontaneously voided volume was >50 mL, urinary retention was observed in less than 10% of attempts. Postpartum urinary retention occurred in nine women (6.7%) with a mean post-void residual volume of 1133 ± 447 mL; all were nulliparous, seven had induced labor, and five had an episiotomy. CONCLUSIONS Women who are able to successfully void during labor have a low risk of intrapartum urinary retention. We would recommend considering catheterization every 3 to 4 hours for women who are unable to urinate spontaneously, void less than 50 ml, or experience complete motor blockade during labor.
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Affiliation(s)
- Willemijn Lips
- Department of Obstetrics and Gynecology, Erasmus Medical Center, the Netherlands.
| | - Corina S Sie
- Department of Anesthesiology, Ikazia Hospital, the Netherlands.
| | - Liv M Freeman
- Department of Obstetrics and Gynecology, Ikazia Hospital, the Netherlands.
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Sultan AA, Berger RJ, Cantrell WA, Samuel LT, Ohliger E, Golubovsky J, Bachour S, Pasadyn S, Karnuta JM, Tamer P, Le P, Kuivila TE, Gurd DP, Goodwin RC. Removal of a urinary catheter before discontinuation of epidural analgesia is associated with an increased risk of postoperative urinary retention and hospital episode costs in patients undergoing surgical correction for adolescent idiopathic scoliosis. Spine Deform 2020; 8:195-201. [PMID: 31981148 DOI: 10.1007/s43390-020-00039-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 06/02/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal instrumented fusion (PSIF), we aimed to answer these questions: (1) is there a difference in postoperative urinary retention (UR) rates among patients who had removal of their Foley catheters before vs. after discontinuation of epidural analgesia (EA)? (2) Can the timing of Foley catheter removal be an independent risk factor for postoperative UR requiring recatheterization? (3) Is there an incurred cost related to treating UR? STUDY DESIGN Retrospective cohort. BACKGROUND EA has been widely used for postoperative pain control after PSIF for AIS. In these patients, removing the Foley catheter, inserted for intraoperative monitoring of urine output, is indicated in the early postoperative period. However, a controversy exists as to whether it should be removed before or after the EA has been discontinued. METHODS A single-institution, longitudinally maintained database was queried to identify 297 patients who met specific inclusion and exclusion criteria. Patient characteristics and the order and timing of removing the urinary and epidural catheters were collected. Rates of UR were statistically compared in patients who had early vs. late urinary catheter removal. A univariate and multivariate regression analysis was conducted to identify independent risk factors. Hospital episode costs were analyzed. RESULTS Patients who had early (n = 66, 22%) vs. late (n = 231, 78%) urinary catheter removal had a significantly higher incidence of UR requiring recatheterization (15 vs. 4.7%, p = 0.007). Patient with early removal were almost 4 times more likely to develop UR requiring recatheterization [odds ratio (OR) 3.8, 95% confidence interval (CI) 1.5-9.7, p = 0.005]. UR incurred additional costs averaging $15,000/patient (p = 0.204). CONCLUSION In patients who had PSIF for AIS, removal of a urinary catheter before discontinuation of EA is an independent risk factor for UR, requiring recatheterization and associated with increased cost. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Ryan J Berger
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - William A Cantrell
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Erin Ohliger
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Joshua Golubovsky
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA
| | - Salam Bachour
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA
| | - Selena Pasadyn
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA
| | - Jaret M Karnuta
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA
| | - Pierre Tamer
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA
| | - Phuc Le
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Thomas E Kuivila
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - David P Gurd
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ryan C Goodwin
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Nevo A, Haidar AM, Navaratnam A, Humphreys M. Urinary Retention Following Non-urologic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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4
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Agrawal K, Majhi S, Garg R. Post-operative urinary retention: Review of literature. World J Anesthesiol 2019; 8:1-12. [DOI: 10.5313/wja.v8.i1.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/11/2018] [Accepted: 01/05/2019] [Indexed: 02/06/2023] Open
Abstract
Postoperative urinary retention (POUR) is one of the postoperative complications which is often underestimated and often gets missed and causes lot of discomfort to the patient. POUR is essentially the inability to void despite a full bladder in the postoperative period. The reported incidence varies for the wide range of 5%-70%. Multiple factors and etiology have been reported for occurrence of POUR and these depend on the type of anaesthesia, type and duration of surgery, underlying comorbidities, and drugs used in perioperative period. Untreated POUR can lead to significant morbidities such as prolongation of the hospital stay, urinary tract infection, detrusor muscle dysfunction, delirium, cardiac arrhythmias etc. This has led to an increasing focus on early detection of POUR. This review of literature aims at understanding the normal physiology of micturition, POUR and its predisposing factors, complications, diagnosis and management with special emphasis on the role of ultrasound in POUR.
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Affiliation(s)
- Kritika Agrawal
- Department of Onco-Anaesthesia, Palliative Care, All-India Institute of Medical Sciences, Delhi 110029, India
| | - Satyajit Majhi
- Department of Anaesthesiology, Max Super-Speciality Hospital, Delhi 110029, India
| | - Rakesh Garg
- Department of Anaesthesiology, Intensive Care, Pain and Palliative Medicine, All India Institute of Medical Sciences, Delhi 110029, India
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Tiberon A, Carbonnel M, Vidart A, Ben Halima M, Deffieux X, Ayoubi JM. Risk factors and management of persistent postpartum urinary retention. J Gynecol Obstet Hum Reprod 2018; 47:437-441. [PMID: 30142472 DOI: 10.1016/j.jogoh.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our objective was to identify the risk factors for persistent postpartum urinary retention (PUR). MATERIAL AND METHODS This multicenter retrospective case-control study included 91 women with PUR exceeding 400ml during the first urinary catheterization performed after delivery, from 2010 through 2015. Two groups were defined: one included 25 women with PUR that persisted longer than 3 days, and the other, comprising 66 women with PUR that lasted three days or less. We compared the two groups to define the risk factors. We also studied the outcome of the women with persistent PUR. RESULTS The time until diagnosis/management and the urinary volume at the first catheterization after delivery were both significantly greater in the group with persistent PUR (11h vs 7.8h and 1020ml vs 715ml, P<0.05). Multivariate logistic regression indicated that cesarean delivery, perineal tear or episiotomy, and fluid administration in the delivery room were also associated with the persistence of PUR (P<0.05). CONCLUSION Time in the management of urinary retention can cause bladder overdistension that can substantially delay its resolution. More attentive monitoring of voiding, could reduce the duration of this complication and thereby improve patient comfort and minimize long-term complications. BRIEF SUMMARY This multicenter retrospective study show that the time in the management of urinary retention is a major factor of persistent urinary retention.
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Affiliation(s)
- A Tiberon
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - M Carbonnel
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France.
| | - A Vidart
- Department of Urology, Foch Hospital, 92150 Suresnes, France
| | - M Ben Halima
- ESCP Europe Business School and Centre d'études de l'emloi (CEE), 75015Paris, France
| | - X Deffieux
- Department of Gynecology and Obstetrics, Antoine Béclère Hospital, 92140 Clamart, France
| | - J-M Ayoubi
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
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Rousseau A, Sadoun M, Aimé I, Leguen M, Carbonnel M, Ayoubi J. Étude comparative sur la réhabilitation améliorée postcésarienne : quels bénéfices, quels risques ? ACTA ACUST UNITED AC 2017; 45:387-392. [DOI: 10.1016/j.gofs.2017.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 11/26/2022]
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7
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Mulder FEM, Hakvoort RA, Schoffelmeer MA, Limpens J, Van der Post JAM, Roovers JPWR. Postpartum urinary retention: a systematic review of adverse effects and management. Int Urogynecol J 2014; 25:1605-12. [DOI: 10.1007/s00192-014-2418-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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8
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Sultan P, Murphy C, Halpern S, Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis. Can J Anaesth 2013; 60:840-54. [DOI: 10.1007/s12630-013-9981-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 02/01/2023] Open
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Mulder FEM, Schoffelmeer MA, Hakvoort RA, Limpens J, Mol BWJ, van der Post JAM, Roovers JPWR. Risk factors for postpartum urinary retention: a systematic review and meta-analysis. BJOG 2012; 119:1440-6. [DOI: 10.1111/j.1471-0528.2012.03459.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Heesen M, Veeser M. Analgesia in Obstetrics. Geburtshilfe Frauenheilkd 2012; 72:596-601. [PMID: 25264376 DOI: 10.1055/s-0031-1298444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/22/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
Abstract
Background: An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients. Methods: We performed a selective literature search in Medline via PubMed using the search-terms "Analgesia" and "Obstetrics". We also included the current guidelines of the German Society for Anesthesiology and Intensive Care Medicine. Results: PDA and CSE are safe techniques for the relief of labour pain if contraindications are excluded. The risk for instrumental delivery but not for caesarean section is increased under neuraxial analgesia. PDA and CSE should be performed in an early stage of labour using low doses of local anaesthetics if possible. It is not necessary to wait for a defined cervical dilatation before starting neuraxial analgesia. Anesthesiologists and obstetricians should inform patients as soon as possible before the situation of stress during labour. Systemic opioid analgesia is a possible alternative for neuraxial techniques. Because of possible side effects systemic remifentanil analgesia should only be performed under continuous monitoring. Several nonpharmacologic methods can also relieve labour pain, but results of studies about their effectiveness are inconsistent.
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Affiliation(s)
- M Heesen
- Anesthesiology, Sozialstiftung Bamberg, Bamberg
| | - M Veeser
- Anesthesiology, Sozialstiftung Bamberg, Bamberg
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11
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Choi S, Mahon P, Awad IT. Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review. Can J Anaesth 2012; 59:681-703. [PMID: 22535232 DOI: 10.1007/s12630-012-9717-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/13/2012] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Urinary retention requiring catheterization carries the risk of infection. Neuraxial anesthesia causes transient impairment of bladder function ranging from delayed initiation of micturition to frank urinary retention. We undertook a review of the literature to determine the elements of neuraxial anesthesia and analgesia that prolong bladder dysfunction and increase the incidence of urinary retention. METHODS We performed a systematic search of the PubMed, MEDLINE, and EMBASE databases (from January 1980 to January 2011) to identify studies where neuraxial anesthesia and/or analgesia were employed and at least one of the following outcomes was reported: urinary retention, time to micturition, or post void residual. We included randomized controlled trials and observational studies published in the English language and we excluded case reports. The randomized trials were graded according to the Jadad score. PRINCIPAL FINDINGS Our search yielded 94 studies, and in 16 of these studies, the authors reported time to micturition after intrathecal anesthesia of varying local anesthetics and doses. Intrathecal injections were performed in 41 of these studies, epidural anesthesia/analgesia was used in 39 studies, and five studies involved both the intrathecal and epidural routes. Meta-analysis was not possible because of the heterogeneity of interventions and reported outcomes. The duration of detrusor dysfunction after intrathecal anesthesia is correlated with local anesthetic dose and potency. The incidence of urinary retention displays a similar trend and is further increased by the presence of neuraxial opioids, particularly long-acting variants. Urinary tract infection secondary to catheterization occurred rarely. CONCLUSIONS Neuraxial anesthesia/analgesia results in transient detrusor dysfunction. The duration of dysfunction depends on the potency and dose of medication used; however, it does not appear to result in significant morbidity.
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Affiliation(s)
- Stephen Choi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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12
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Abstract
Bladder outlet obstruction in females remains a poorly understood condition and is much rarer as compared to males. More difficult is the objective diagnosis of this condition. There is no general agreement on the Urodynamic parameters to define the condition with certainty. A number of conditions are involved particularly in urinary retention in females are not completely understood. Besides, external sphincter dysfunction and post surgical retentions add another group of conditions which are distinct from retentions seen in the males. This article takes a review of various aetiological factors of Bladder outlet obstruction in women. An attempt is made to standardise the Urodynamic parameters for use in females, based on our data and experimentation on the models of the bladder and urethra. This article also takes a review of uncommon conditions such as Fowler's syndrome which often complicate evaluation of this condition.
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Affiliation(s)
- Shirish Yande
- Centre for Advanced Urodynamics, Ratna Memorial Hospital, Pune, India
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13
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Abstract
Urinary retention (UR) can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men but symptomatic UR is unusual in women. The epidemiology of female UR is not well documented. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional; labeling symptoms as having a “psychogenic basis” should be avoided. Detrusor failure is often an underlying factor that complicates interpretation. Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes. Investigations should be focused on identifying the underlying etiology and any reversible factor. A detailed history, general and pelvic examination are needed; urine dipstick analysis, routine microscopy and culture, and pelvic and renal ultrasound are suitable baseline investigations. Urodynamic tests are required in specific situations. Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis. Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected. Follow-up is needed for monitoring response to treatment, detection of complications and symptom control. Fowler’s syndrome is a specific group diagnosed on urethral sphincter electromyogram, representing a very challenging clinical scenario.
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Affiliation(s)
- Amit Mevcha
- Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, UK
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14
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Bouhours AC, Bigot P, Orsat M, Hoarau N, Descamps P, Fournié A, Azzouzi AR. [Postpartum urinary retention]. Prog Urol 2011; 21:11-7. [PMID: 21193140 DOI: 10.1016/j.purol.2010.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 07/14/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
Abstract
Postpartum urinary retention is an uncommon event that occurs in 0.7 to 0.9% of vaginal deliveries. An ignorance of this situation can lead to delayed diagnosis worsening the prognosis and to inadequate treatments. This complication is defined as the absence of spontaneous micturition within 6hours of vaginal delivery with a bladder volume above 400mL. The etiology depends on multiple factors. Because of physiological changes during pregnancy, the bladder is hypotonic with an increased post-void residual volume. The occurrence of a perineal neuropathy during delivery may cause a urinary retention. Risk factors are primiparity, prolonged labour, instrumental delivery and perineal lacerations. Treatment consists on clean intermittent catheterization and recovery occurs generally in 72hours. Persistent urinary retention is the principal short-term complication and should be treated by clean intermittent self-catheterization. Long-term consequences are poorly reported in the literature.
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Affiliation(s)
- A C Bouhours
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49933 Angers, France
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Abstract
The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum. An array of regional nerve blocks, systemic analgesic, and nonpharmacologic techniques are currently used for labor analgesia. Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study. Continuous labor support has been shown to decrease the use of pharmacologic analgesia and shorten labor. Intradermal water injections decrease back labor pain. Neuraxial labor analgesia (most commonly epidural or combined spinal-epidural) is the most effective method of pain relief during childbirth, and the only method that provides complete analgesia without maternal or fetal sedation. Current techniques commonly combine a low dose of local anesthetic (bupivacaine or ropivacaine) with a lipid soluble opioid (fentanyl or sufentanil). Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.
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Affiliation(s)
- Cynthia A Wong
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Wilson M, MacArthur C, Shennan A. Urinary catheterization in labour with high-dose vs mobile epidural analgesia: a randomized controlled trial. Br J Anaesth 2009; 102:97-103. [DOI: 10.1093/bja/aen313] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Musselwhite KL, Faris P, Moore K, Berci D, King KM. Use of epidural anesthesia and the risk of acute postpartum urinary retention. Am J Obstet Gynecol 2007; 196:472.e1-5. [PMID: 17466708 DOI: 10.1016/j.ajog.2006.11.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 09/18/2006] [Accepted: 11/29/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to examine the relationship between the use of epidural analgesia during labor and acute postpartum urinary retention. STUDY DESIGN A retrospective cohort study was conducted using 1994 labor and postpartum health records from 3 primary care centers. RESULTS Logistic regression analysis revealed that a longer second stage of labor (odds ratio [OR] 2.62; 95% confidence interval [CI] 1.41-4.85), use of systemic narcotics (OR 1.63; 95% CI 1.04-2.57), perineal laceration (OR 1.73; 95% CI 1.02-2.91), and instrumental delivery (OR 1.86; 95% CI 1.16-2.97) predicted urinary retention. There was a trend toward association of epidural analgesia and urinary retention (OR 1.69; 95% CI 0.98-2.92). Propensity score analysis revealed that any effect of epidural analgesia was likely due to effect modification of other obstetric variables. CONCLUSION Epidural analgesia during labor may increase the risk of developing urinary retention by up to 3 times. However, this effect is mediated by other obstetric variables.
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18
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Kim HM, Yang WJ, Chung JY, Sung KH, Sung YB, Lee S. A Study of Frequency and Factors of Voiding Dysfunction Occurred after Epidural Anesthesia Using Bupivacaine. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.8.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Han Min Kim
- Department of Urology, Inje University College of Medicine, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jae Yong Chung
- Department of Urology, Inje University College of Medicine, Korea
| | - Ki Heok Sung
- Department of Orthopedic Surgery, Inje University College of Medicine, Korea
| | - Yerl-Bo Sung
- Department of Orthopedic Surgery, Inje University College of Medicine, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Inje University College of Medicine, Korea
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Roelants F, Mercier-Fuzier V, Lavand'homme PM. The Effect of a Lidocaine Test Dose on Analgesia and Mobility After an Epidural Combination of Neostigmine and Sufentanil in Early Labor. Anesth Analg 2006; 103:1534-9. [PMID: 17122235 DOI: 10.1213/01.ane.0000244595.03322.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We previously demonstrated the effectiveness of epidural sufentanil and the cholinesterase inhibitor, neostigmine, to initiate selective labor analgesia. Because the traditional lidocaine plus epinephrine test dose (TD) may alter the effect of subsequent epidural drugs, we undertook this investigation to evaluate the impact of a lidocaine TD on analgesia from a combination of epidural neostigmine plus sufentanil administered in early labor. Eighty healthy parturients were randomly allocated to two groups to receive a 3 mL-TD, either lidocaine 2%-epinephrine (1:200,000) or saline-epinephrine (1:200,000), followed 3 min later by epidural neostigmine 500 microg plus sufentanil 10 microg. Pain scores were recorded for 30 min after injection, as was the time elapsed from initial bolus until request for supplemental analgesia. Thirty minutes after injection, adequacy of motor function was evaluated by the parturient's ability to sit, stand up, bend her knees, and walk. Lidocaine TD hastened the onset (5 min vs 15 min) and increased duration (122 +/- 53 min vs 98 +/- 54 min; P = 0.02) of analgesia from epidural neostigmine plus sufentanil bolus. In contrast, the TD did not significantly impair the ability to sit, stand up, or bend the knees. The ability to ambulate, however, was reduced (57% vs 82%; P = 0.04). In conclusion, a traditional lidocaine TD significantly enhances the analgesic effect from the epidural neostigmine plus sufentanil combination, but affects ambulation in early labor.
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Affiliation(s)
- Fabienne Roelants
- Department of Anesthesiology, Université Catholique de Louvain, St. Luc Hospital, Av Hippocrate 10-1821, 1200 Brussels, Belgium
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Teo R, Punter J, Abrams K, Mayne C, Tincello D. Clinically overt postpartum urinary retention after vaginal delivery: a retrospective case-control study. Int Urogynecol J 2006; 18:521-4. [PMID: 16927042 DOI: 10.1007/s00192-006-0183-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 06/28/2006] [Indexed: 12/01/2022]
Abstract
We set out to determine the incidence of symptomatic postpartum urinary retention (PUR) after vaginal delivery and to establish any associated risk factors. We carried out a retrospective case-control study of women having PUR after vaginal delivery from 2001 to 2005. Four controls, matched for date of delivery, were selected for each case in univariate and multivariate conditional logistic regression analyses. There were 15,757 deliveries and 30 cases of PUR (incidence 0.2%). Median duration of PUR was 19 days (range 3-85). Eighty percent were managed with intermittent self-catheterization. The use of regional analgesia increased the risk of PUR [odds ratio (OR) 6.33, 95% confidence interval (CI) 2.01-19.96], while ethnicity (Caucasian vs Asian) reduced the risk (OR 0.27, CI 0.08-0.85) (p<0.05). PUR is uncommon but carries significant morbidity. Epidural analgesia and Asian ethnic origin increase the risk. We recommend routine catheterization for up to 24 h after delivery after epidural analgesia.
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Affiliation(s)
- Roderick Teo
- Urogynaecology Department, Leicester General Hospital, Gwendolen Road, Leicester, UK.
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Eriksson SL, Blomberg I, Olofsson C. Single-shot intrathecal sufentanil with bupivacaine in late labour--analgesic quality and obstetric outcome. Eur J Obstet Gynecol Reprod Biol 2003; 110:131-5. [PMID: 12969571 DOI: 10.1016/s0301-2115(03)00049-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the analgesic effect and obstetric outcome after single-shot intrathecal sufentanil with bupivacaine in late labour. STUDY DESIGN Forty multiparous women in advanced labour were given a spinal injection of sufentanil 7.5 microg and bupivacaine 2 mg. Pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded. Apgar score and umbilical artery pH were noted. RESULTS Median visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were 1.5, 0.5, 0, 1, 1.5, 2 and 3, respectively. Seventy-seven percent of the parturients scored the analgesic quality as excellent. Six parturients had hypotension. Motor block, sedation and nausea were rare. Pruritus was seen in 85% of the cases. No ceasarean section was performed. Vacuum extraction was done in six (15%) cases. Oxytocin augmentation was needed in 26 (65%) of the parturients. Fetal heart rate disturbances following the spinal block were seen in four cases. Apgar scores were high. No neonate had Apgar < 7. CONCLUSIONS Intrathecal block with sufentanil 7.5 microg in combination with bupivacaine 2 mg is a very effective pain relief in late labour. Due to its limited duration it is important to select women in rapid progress of labour, and active obstetric management is necessary. It is also very important that the obstetrician is aware of the risk of non-reassuring fetal heart rate changes after intrathecal block.
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Affiliation(s)
- Susanne Ledin Eriksson
- Department of Anaesthesiology and Intensive Care, Gävle-Sandviken County Hospital, SE-80187, Gavle, Sweden.
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Hart EM, Ahmed N, Buggy DJ. Impact study of the introduction of low-dose epidural (bupivacaine 0.1%/fentanyl 2μg.mL−1) compared with bupivacaine 0.25% for labour analgesia. Int J Obstet Anesth 2003; 12:4-8. [PMID: 15321514 DOI: 10.1016/s0959-289x(02)00097-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We conducted a retrospective analysis of the obstetric effects of introducing a low-dose epidural regimen for epidural analgesia in labour. Before this, all women in our unit requesting epidural analgesia for labour received intermittent boluses (10 mL) of 0.25% bupivacaine. After the introduction of the low-dose service in March 2000, intermittent boluses (10 mL) of 0.1% bupivacaine with fentanyl 2 microg . mL(-1) were given. The records of 300 women were examined, 150 who had received the standard regimen before the introduction of the new service and 150 women afterwards. The groups were compared for outcome of labour, quality of analgesia and any adverse events related to the epidural analgesia. There was a significant reduction in the low-dose group in the number of women requiring instrumental delivery (41% vs. 29%, P = 0.04). The need for indwelling bladder catheters was also reduced in the patients receiving the low-dose regimen (21.3% vs. 4.7%, P < 0.001). Duration of analgesia was longer in patients receiving bupivacaine 0.25% (mean minimum time between boluses 42.25 +/- 33.8 vs. 24.37 +/- 19.8 min, P < 0.001). The need for further anaesthetic intervention was higher with the low-dose regimen (24% vs. 34%, P = 0.037). Maternal satisfaction was high in both groups (95 and 97%, respectively). We conclude that the introduction of a low-dose regimen of epidural analgesia for labour reduces the incidence of instrumental deliveries. It also decreases the incidence of bladder catheterisation during labour, but the need for anaesthetic intervention may be greater.
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Affiliation(s)
- E M Hart
- Department of Anaesthesia, University Hospitals of Leicester, Leicester General Hospital, UK.
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Huang C, Macario A. Economic considerations related to providing adequate pain relief for women in labour: comparison of epidural and intravenous analgesia. PHARMACOECONOMICS 2002; 20:305-318. [PMID: 11994040 DOI: 10.2165/00019053-200220050-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Epidural analgesia and intravenous analgesia with opioids are two techniques for providing pain relief for women in labour. Labour pain is comparable to surgical pain in its severity, and epidural analgesia provides better relief from this pain than intravenous analgesia; a meta-analysis quantified this improvement to be 40 mm on a 100mm pain scale during the first stage of labour. Epidural analgesia also has fewer adverse effects. However, providing epidural analgesia for labour pain costs more. The full cost of providing epidural analgesia can be divided into two components: a baseline-cost component, which captures the costs of hospital care to parturients receiving intravenous analgesia for labour pain; and an incremental-cost component, which estimates the costs arising from incremental care specific to epidural analgesia. The baseline component may be constructed using hospital cost-accounting data pertaining to actual obstetric patients. The incremental component is constructed from a set of recognised complications of epidural and intravenous analgesia, associated incidence rates and estimates of the costs involved, from society's perspective. The incremental expected cost per patient to society of providing epidural analgesia was calculated to be approximately $US338 (1998 values). This cost difference results primarily from increased professional costs (and is particularly sensitive to the method used to estimate the cost of anaesthesia professional services) and increased complication costs associated with epidural analgesia. A rational social policy for providing labour analgesia must weigh the value of improved pain relief from epidural analgesia against the increased cost of epidural analgesia.
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Affiliation(s)
- Cecil Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA.
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Eriksson SL, Frykholm P, Stenlund PM, Olofsson C. A comparison of three doses of sufentanil in combination with bupivacaine-adrenaline in continuous epidural analgesia during labour. Acta Anaesthesiol Scand 2000; 44:919-23. [PMID: 10981566 DOI: 10.1034/j.1399-6576.2000.440804.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sufentanil is now frequently added to local anaesthetic in labour epidural analgesia. However, this opioid has some side effects such as pruritus, and in higher doses could harm the neonate. The purpose of this study was to compare three doses of sufentanil combined with low-dose bupivacaine, to determine the lowest appropriate dose. METHOD In a prospective, randomized, double-blind study, 243 parturients were randomized, to receive A--0.5 microg/ml, or B--0.75 microg/ml or C--1 microg/ml sufentanil, in addition to bupivacaine 0.625 mg/ml+adrenaline 1.25 microg/ml. All were given an 8 ml bolus of the study solution, followed by continuous infusion at 6 ml/h. The analgetic effect was scored on a visual analogue scale (VAS). Onset quality was measured as VAS after 20 min, the total effect as VAS maximum during the first stage of labour. Overall maternal satisfaction was recorded within two hours post partum. Side effects were noted. RESULTS There were no differences between groups in VAS assessments after 20 min or in maximum registered VAS. In group A, 83% had VAS 0-4 after 20 min, in group B 77% and in group C 71%. Maximum VAS during the first stage was 0-4 for 60% of group A, 68% of group B and 61% of group C. Maternal satisfaction was also the same in the three groups. In group A, 70% reported excellent effect and 22% good effect. The corresponding figures in group B were 68% and 24% respectively, and in group C 62% and 24% respectively. Group A received a mean total dose of 21 microg sufentanil, group B 30 microg and group C 44 microg. Pruritus occurred in 51% of group A, 53% of group B and 65% of group C. CONCLUSION We found no difference in the analgesic effect between three different concentrations of sufentanil. We conclude that the lowest dose may be used. This should decrease the risk of adverse effects on mother and child.
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Affiliation(s)
- S L Eriksson
- Department of Anaesthesiology and Intensive Care, Gävle-Sandviken County Hospital, Stockholm, Sweden
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Greene MF. Trial of calcium to prevent preeclampsia. J Womens Health (Larchmt) 1997; 6:485-6. [PMID: 9312416 DOI: 10.1089/jwh.1997.6.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- M F Greene
- Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, USA
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