Postoperative Urinary Catheterization in Children Treated with or without Epidural Analgesia after Orthopedic Surgery: A Retrospective Review of Practice
Yotam Lior, Shimon Haim, Idan Katz, Barry Danino, Yuval Bar-Yosef, Margaret Ekstein, Yotam Lior, Shimon Haim, Idan Katz, Barry Danino, Yuval Bar-Yosef, Margaret Ekstein
Abstract
Epidural analgesia is effective and an accepted treatment for postoperative pain. Urinary retention is a known complication, but its description is mostly in the adult literature. Management of urinary catheter (UC) placement and removal is an important consideration in children receiving epidural analgesia. This is a single-center, retrospective observational study which examined UC management in children undergoing lower extremity orthopedic surgery under general anesthesia with or without epidural analgesia from January 2019−June 2021. Of 239 children included, epidural analgesia was used in 57 (23.8%). They were significantly younger and had more co-morbidities. In total, 75 UCs were placed in the OR, 9 in the ward, and 7 re-inserted. UC placement in the epidural group was more common (93% vs. 17%, p < 0.001) and remained longer (3 days vs. 1 day, p = 0.01). Among children without intra-operative UC, ward placement was more common in the epidural cohort (60% vs. 1.6%, p = 0.007). OR UC placement and ward re-insertion were more common in children with neuromuscular disease (61% vs. 22%, p < 0.001), (17% vs. 3%, p = 0.001), respectively. Based on these findings, we hypothesize that it is justifiable to routinely place a UC intra-operatively in children who undergo hip or lower extremity surgery and are treated with epidural analgesia, and caution is advised before early UC removal in orthopedic children with NMD.
Keywords: epidural analgesia; lower extremity orthopedic surgery; neuromuscular disease; postoperative urinary retention; urinary catheter.
Conflict of interest statement
There was no extra-institutional funding or sponsorship for this study. There is no direct or indirect financial incentive associated with the publication of this manuscript and therefore the authors declare no conflict of interest.
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Source: PubMed