DOES SPINAL ANESTHESIA FOROUTPATIENT UROGYNECOLOGIC SURGERY INCREASE RATES OF URINARYRETENTION: A RANDOMIZED CONTROLLED TRIAL
A. ALEXANDRIAH1, L.MARTIN 2, H. DEVAKUMAR 2, N. CHANDRASEKARAN 2,G. DAVILA 2, E. A. HURTADO 2;
1Urogynecology,Univ. of Texas Hlth.Sci. Ctr. San Antonio, San Antonio, TX,2Cleveland Clinic Florida, Weston, FL.
Introduction: Spinal anesthesiahas been linked to postoperative urinary retention (POUR) in variousnon-gynecological surgical procedures.1 In addition, arecent study reported a significantly higher POUR rate after slingsurgery in patients who underwent a spinal compared to generalanesthesia, 61.9% vs. 24.7% (p < 0.001).2 However,studies are limited to retrospective reviews, with no standardvoiding trial protocol and are performed on various post-operativedays.
Objective: To compare POUR rates for same day vaginalpelvic floor surgeries when using spinal versus generalanesthesia.
Methods: This was a randomized controlled trialat a single institution on patients undergoing outpatient pelvicorgan prolapse surgery with a concomitant incontinence sling.Subjects underwent a baseline history and physical, a post-voidresidual (PVR), and urodynamics (UDS) if clinically indicated.Subjects were excluded if they had a PVR < 150 cc on more than oneoccasion, were <40 years of age, surgery was < 1 hour, or hadcontraindications to spinal or general anesthesia. Patients completeda validated survey, the Quality of Recovery-15 (QoR-15), prior tosurgery, on the phone at 48-72 hours, and at their 6-weekpostoperative visit. A standardized voiding trial was performed byinstilling the bladder with 300 cc of saline in the recovery areaafter subjects were able to ambulate. POUR was defined as theinability to void two-thirds of the volume that was instilled intothe bladder. The primary aim was to compare the incidence of POURbetween anesthesia groups. Secondary outcomes were to comparecomplications, and patient recovery scores. Based on a prior study,28 subjects were required per group to detect 37% difference with 80%power and an alpha of 0.05.2
Results: A total of55 subjects were randomized. Two were excluded as they received bothspinal and general anesthesia, leaving 24 in the spinal group and 29in the general group. There were no baseline differences among thegroups (Table 1). There was no difference in POUR rates betweenspinal and general anesthesia (87.5% vs. 82.8%, p=0.6313),respectively. There was noted to be higher a POUR rate in thosesubjects with higher baseline PVRs (p=0.0029), lower UDS Qmax(p=0.0313), higher estimated blood loss (p=0.014), and thoserequiring longer time to complete the voiding trial (p=0.0187, Table2). There was no difference in QoR-15 scores between spinal andgeneral anesthesia at 48 hours (p=0.9223) or at 6-weeks (0.0728).There was no difference in complication rates, hematomas, Foleycatheter reinsertions after a successful voiding trial, orreadmission rates.
Conclusions: Based on this study, theredoes not appear to be a higher risk of POUR or complications with theuse of spinal anesthesia for pelvic organ prolapse surgery withincontinence slings. If surgical patients are candidates and wouldbenefit from spinal anesthesia, the risk of urinary retention shouldnot be considered as a reason to not utilize this form ofanesthesia.
References: 1. Anesthesiology.2009;110(5):1139-1157 2. Am J Obstet Gynecol. 2009 May;200(5):571