Management of bladder volumes when using neuraxial anesthesia

Area of Science:

• Anesthesiology
• Urology

Background:

• Neuraxial blockade is commonly used for outpatient procedures.
• Maintaining bladder function post-procedure is crucial for patient recovery and discharge.
• Postoperative urinary retention (POUR) can be a complication.

Purpose of the Study:

• To outline key principles for managing bladder function during outpatient neuraxial blockade.
• To differentiate management strategies for low-risk versus high-risk patients regarding urinary retention.

Main Methods:

• Review of current literature and clinical guidelines on neuraxial blockade and bladder management.
• Identification of anesthetic choices, fluid management strategies, and monitoring techniques.
• Analysis of risk factors associated with postoperative urinary retention.

Main Results:

• Key management principles include using short-acting local anesthetics, avoiding epinephrine, and administering 750-1000 mL of fluids.
• Low-risk patients have similar retention risks as with general anesthesia and can be discharged with voiding instructions.
• High-risk patients may require bladder ultrasound (BUS) monitoring and catheterization if bladder volumes exceed 600 mL.

Conclusions:

• Effective management of bladder function during outpatient neuraxial blockade is achievable through specific anesthetic and fluid strategies.
• Risk stratification is essential, guiding the need for closer monitoring and intervention in high-risk individuals.
• Adherence to these principles can minimize the incidence and impact of postoperative urinary retention.