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Continuous thoracic epidural analgesia does not increase the incidence of urinary retention after pulmonary resection

We aimed to examine the relationship between the use of continuous thoracic epidural analgesia (TEA) and acute urinary retention after pulmonary resection. This prospective study was conducted over 1 year with institutional review board approval. After written informed consent 178 patients ASA I-III scheduled for lobectomy were allocated to 2 groups. Group 1 (n=104) received continuous TEA with general anesthesia and group 0 (n=74) had general anesthesia only. Before general anesthesia started, TEA was performed by the same group of anesthesiologist, using loss-of-resistance saline, to find the epidural space at the level Th3 - Th5 trough the midline in the sitting position. After negative aspiration and a negative test-dose (2% lidocain 40 mg plus epinefrin 10 µg) continuous epidural infusion (0, 5% levobupivacain 10 ml plus sufentanil 40 µg plus epinefrin 80 µg and 18 ml saline) was started 5-10 ml/hour. TEA was continued during post-operative period in ICU. The general anesthesia was induced with midazolam, propofol, sufentanil and rocuronium. We observed incidence of urinary catheterization (urinary retention only) during first 24 hours postoperatively between group 0 and 1. All statistical analyses were performed using STATISTICA version 6.0 (Stat Soft, Tulsa, USA). P< 0.05 was considered statistically significant. The study included 178 patients, 137 men (77%) and 41 women (23%) with a mean age of 60 (+/- 0.12 SD). Thoracic epidural catheter had 104 (58.4%) patients compared to 74 (41.6%) who had no epidural catheter. There were no significant differences between the two groups in the incidence of urinary retention. We found that the risk of urinary retention was 69% less in women than in men (OR = 0.31 ; 95% CI ; 0.11- 0.84 ; P = 0.021). Continuous TEA does not increase the incidence of urinary retention after pulmonary resection.

thoracic epidural analgesia; urinary retention; pulmonary resection

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