Postoperative Urinary Catheterization in Children Treated with or without Epidural Analgesia after Orthopedic
Yotam Lior1, Shimon Haim1, Idan Katz1
1Divisiona of Anesthesia, Intensive Care, and Pain Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel.
Insights
Children receiving epidural analgesia for lower extremity surgery often require urinary catheters. Routine intra-operative catheterization and cautious removal are recommended, especially for those with neuromuscular disease.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Urology
Background:
- Epidural analgesia is a common postoperative pain management strategy for children undergoing orthopedic surgery.
- Urinary retention is a known complication of epidural analgesia, though less documented in pediatric populations.
- Effective management of urinary catheter (UC) use is crucial in pediatric patients receiving epidural analgesia.
Purpose of the Study:
- To examine urinary catheter management in children undergoing lower extremity orthopedic surgery.
- To compare UC placement and removal practices between children receiving and not receiving epidural analgesia.
- To identify factors influencing UC management, including neuromuscular disease.
Main Methods:
- Single-center, retrospective observational study.
- Inclusion of 239 children undergoing lower extremity orthopedic surgery (January 2019–June 2021).
- Analysis of UC placement, duration, and re-insertion in relation to epidural analgesia and neuromuscular disease.
Main Results:
- Epidural analgesia was used in 57 (23.8%) children, who were younger and had more comorbidities.
- Children receiving epidural analgesia had higher rates of intra-operative UC placement (93% vs. 17%) and longer catheter duration (3 days vs. 1 day).
- Intra-operative UC placement and ward re-insertion were significantly more common in children with neuromuscular disease.
Conclusions:
- Routine intra-operative urinary catheter placement is justifiable for pediatric patients undergoing hip or lower extremity surgery with epidural analgesia.
- Caution is advised regarding early urinary catheter removal in orthopedic pediatric patients with neuromuscular disease.
- Further research into optimal UC management protocols in this population is warranted.
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.
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