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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 November;77(11):1050-7
Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization
Balderi T. 1, Mistraletti G. 2, D’Angelo E. 2, Carli F. 3 ✉
1 Service of Anesthesia and Resuscitation IV, Department of Surgery, University of Pisa, Pisa, Italy;
2 Deparment of Anesthesiology, Intensive Care and Dermatological Sciences, University of Milan, Milan, Italy;
3 Department of Anesthesia, McGill University Hospital, Montreal, QC, Canada
BACKGROUND: Postoperative urinary retention (POUR) following lower limb arthroplasty is a common complication. The aim of this observational study was to establish the incidence of POUR and assess the usefulness of an ultrasonographic nurse-driven protocol, thereby avoiding elective bladder catheterization.
METHODS: Two-hundred and eighty six consecutive patients undergoing elective hip and knee arthroplasty were retrospectively studied. None of the patients received elective bladder catheterization. Data on risk factors for POUR, urinary tract infections, length of hospital stay and analgesia were collected. Student’s t, Wilcoxon rank-sum, ANOVA and Kruskall-Wallis tests were performed for comparison among two or more groups. Categorical variables were studied using Pearson’s χ2 test. Results were considered significant when the P value <0.05.
RESULTS: Of the 286 patients studied, 49 (17%) required indwelling catheter for 24-48 h. Patients who had POUR had more risk factors (P<0.05) and had longer hospital stays (P<0.05). When comparing analgesia, continuous peripheral nerve block (CPNB) had the least impact on POUR (15.8%), while epidural analgesia had the greatest impact (48.1%).
CONCLUSION: Bladder scanners timely detect POUR following lower joint arthroplasty, making elective bladder catheterization unnecessary.