POST-OPERATIVE URINARY RETENTION AFTER SPINAL ANESTHESIA IN HERNIA SURGERY: A PROSPECTIVE, COMPARATIVE DOUBLE-BLIND STUDY BETWEEN ROPIVACAINE HEAVY 0.75% AND BUPIVACAINE HEAVY 0.5%

HETAL KANABAR; DIPTI DESAI; DINESH C BABARIYA; LAXMI YADAV; KANVEE M VANIA

doi:10.22159/ajpcr.2024v17i7.51086

Authors

HETAL KANABAR Department of Anaesthesiology, GMERS Medical College and Hospital, Junagadh, Gujarat, India.
DIPTI DESAI Department of Anaesthesiology, GMERS Medical College and Hospital, Junagadh, Gujarat, India.
DINESH C BABARIYA Department of Anaesthesiology, GMERS Medical College and Hospital, Junagadh, Gujarat, India.
LAXMI YADAV Department of Anaesthesiology, GMERS Medical College and Hospital, Junagadh, Gujarat, India.
KANVEE M VANIA Department of Anaesthesiology, GMERS Medical College and Hospital, Junagadh, Gujarat, India.

DOI:

https://doi.org/10.22159/ajpcr.2024v17i7.51086

Keywords:

Fixed-dose spinal anesthesia, Urinary retention, Ultrasound-guided bladder volume measurement, Modified Bromage scale, Romberg test, Time to first spontaneous voiding

Abstract

Objective: The objective of this study was to evaluate and compare the effect of spinal anesthesia (SA) with bupivacaine and ropivacaine on recovery of bladder function and time of ambulation in healthy men who were scheduled for hernia surgery.

Methods: In this double-blind study, 60 patients of the American Society of Anesthesiologists I/II/III were assigned to Group B (bupivacaine)/Group R (ropivacaine). Before SA, ultrasonography-guided bladder volume was measured. After the operation, bladder volume was measured continuously every 2 hourly until the patient could void urine spontaneously or need of catheterization. Motor blockade and time of ambulation were recorded.

Results: Bromage scale at 4 h was significantly higher (p=0.0001) in ropivacaine showing intrathecal ropivacaine 3.5 mL produce shorter motor blockade then 3.5 mL bupivacaine. Both Group R and Group B were comparable in terms of ability to void urine (p>0.05), time to complete ambulation without support (p>0.05), and time to negative Romberg test (p>0.05). Negative correlation was found between the first spontaneous void urine and the modified Bromage scale.

Conclusions: After SA with bupivacaine, only two patients developed post-operative urinary retention and none in the ropivacaine. However, Group R required lesser time to void and early recovery of motor function. The time to first void urine was more than the time for complete ambulation (1–3.5 h after ambulation).

Downloads

Download data is not yet available.

References

Kreutziger J, Frankenberger B, Luger TJ, Richard S, Zbinden S. Urinary retention after spinal anaesthesia with hyperbaric prilocaine 2% in an ambulatory setting. Br J Anaesth. 2010 May;104(5):582-6. doi: 10.1093/bja/aeq054, PMID: 20338955

Lingaraj K, Ruben M, Chan YH, Das SD. Identification of risk factors for urinary retention following total knee arthroplasty: A Singapore hospital experience. Singapore Med J 2007;48:213-6.

Geller EJ. Prevention and management of postoperative urinary retention after urogynecologic surgery. Int J Womens Health. 2014 Aug 28;6:829-38. doi: 10.2147/IJWH.S55383, PMID: 25210477; PMCID: PMC4156001

Haleem S, Ozair A, Singh A, Hasan M, Athar M. Postoperative urinary retention: A controlled trial of fixed-dose spinal anaesthesia using bupivacaine versus ropivacaine. J Anaesthesiol Clin Pharmacol. 2020 Jan-Mar;36(1):94-9. doi: 10.4103/joacp.JOACP_221_18

Cataldo PA, Senagore AJ. Does alpha sympathetic blockade prevent urinary retention following anorectal surgery? Dis Colon Rectum. 1991 Dec;34(12):1113-6. doi: 10.1007/BF02050073, PMID: 1959461

Stallard S, Prescott S. Postoperative urinary retention in general surgical patients. Br J Surg. 1988 Nov;75(11):1141-3. doi: 10.1002/ bjs.1800751128, PMID: 3208051

Mulroy MF, Larkin KL, Hodgson PS, Helman JD, Pollock JE, Liu SS. A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2000 Oct;91(4):860-4. doi: 10.1097/00000539-200010000-00017, PMID: 11004038

Gedney JA, Liu EH. Side-effects of epidural infusions of opioid bupivacaine mixtures. Anaesthesia. 1998 Dec;53(12):1148-55. doi: 10.1046/j.1365-2044.1998.00636.x, PMID: 10193215

Gautier PE, De Kock M, Van Steenberge A, Poth N, Lahaye-Goffart B, Fanard L, et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology. 1999 Nov;91(5):1239-45. doi: 10.1097/00000542- 199911000-00013. PMID: 10551572

Kamphuis ET, Ionescu TI, Kuipers PW, de Gier J, van Venrooij GE, Boon TA. Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology. 1998 Feb;88(2):310-6. doi: 10.1097/00000542- 199802000-00007, PMID: 9477049

Gupta A, Axelsson K, Thörn SE, Matthiessen P, Larsson LG, Holmström B, et al. Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: A comparison between 6 mg and 7.5 mg of bupivacaine. Acta Anaesthesiol Scand. 2003 Jan;47(1):13-9. doi: 10.1034/j.1399-6576.2003.470103.x, PMID: 12492791

Frey K, Holman S, Mikat-Stevens M, Vazquez J, White L, Pedicini E, et al. The recovery profile of hyperbaric spinal anesthesia with lidocaine, tetracaine, and bupivacaine. Reg Anesth Pain Med. 1998 Mar-Apr;23(2):159-63. doi: 10.1097/00115550-199823020-00008, PMID: 9570604

Axelsson K, Möllefors K, Olsson JO, Lingårdh G, Widman B. Bladder function in spinal anaesthesia. Actass Anaesthesiol Scand. 1985 Apr;29(3):315-21. doi: 10.1111/j.1399-6576.1985.tb02207.x. PMID: 3993320

Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: Anesthetic and perioperative considerations. Anesthesiology. 2009 May;110(5):1139-57. doi: 10.1097/ALN.0b013e31819f7aea, PMID: 19352147

van Kleef JW, Veering BT, Burm AG. Spinal anesthesia with ropivacaine: A double-blind study on the efficacy and safety of 0.5% and 0.75% solutions in patients undergoing minor lower limb surgery. Anesth Analg. 1994 Jun;78(6):1125-30. PMID: 8198269

Kulkarni KR, Deshpande S, Namazi I, Singh SK, Kondilya K. A comparative evaluation of hyperbaric ropivacaine versus hyperbaric bupivacaine for elective surgery under spinal anesthesia. J Anaesthesiol Clin Pharmacol. 2014 Apr;30(2):238-42. doi: 10.4103/0970- 9185.130031. PMID: 24803765; PMCID: PMC4009647

Malhotra R, Johnstone C, Halpern S, Hunter J, Banerjee A. Duration of motor block with intrathecal ropivacaine versus bupivacaine for caesarean section: A meta-analysis. Int J Obstet Anesth. 2016 Aug;27:9- 16. doi: 10.1016/j.ijoa.2016.03.004, PMID: 27106206

Hinkle DE, Wiersma W, Jurs SG. Rule of thumb for interpreting the size of a correlation coefficient. In: Applied Statistics for the Behavioral Sciences. 5th ed. Boston: Houghton Mifflin; 2003. Available from: http://oak.ucc.nau.edu/rh232/courses/eps525/handouts/correlation%20 coefficient%20handout%20%20 hinkle%20et%20al.pdf