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Investigating Urinary Complications in Young Infant Surgical Patients with Indwelling Epidural Catheters: A
Mihaela Visoiu1, Dahye Park2, Erin E Simonds3
1Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
Insights
Removing Foley catheters before discontinuing continuous epidural analgesia (CEA) in infants prevents postoperative urinary retention (POUR). This approach also reduces urinary tract infection (UTI) risks associated with prolonged catheter use in pediatric patients.
Area of Science:
- Pediatric Anesthesiology and Pain Management
- Urology and Postoperative Care
- Infant Surgical Outcomes
Background:
- Continuous epidural analgesia (CEA) is a standard for pediatric postoperative pain management.
- CEA can lead to postoperative urinary retention (POUR), often requiring Foley catheterization.
- Foley catheter use increases the risk of urinary tract infections (UTIs) in infants.
Purpose of the Study:
- To investigate the frequency of POUR and UTIs in infants receiving CEA.
- To identify factors influencing optimal Foley catheter management during CEA.
- To evaluate the impact of Foley catheter removal timing relative to epidural discontinuation.
Main Methods:
- Retrospective analysis of 103 infants undergoing surgery with CEA at UPMC Children's Hospital of Pittsburgh.
- Patients categorized into three groups based on Foley catheter management: removal before epidural discontinuation (Group A), after (Group B), or no catheter (Group C).
- Data collected on demographics, urinary complications, epidural and opioid analgesia, and Foley catheter management.
Main Results:
- Two infants (1.9%) without a Foley catheter developed POUR; no POUR occurred in infants with catheters removed before epidural discontinuation.
- Two infants (1.9%) in Group B (catheter removed after epidural) developed UTIs.
- Opioid administration was significantly higher in groups with Foley catheters compared to the no-catheter group.
Conclusions:
- Removing Foley catheters prior to epidural discontinuation effectively prevents POUR in infants.
- UTIs were associated with Foley catheters remaining in place after epidural discontinuation.
- Individualized assessment for urinary catheterization and timely removal are crucial for infants receiving CEA.
Background/Objectives:
Continuous epidural analgesia (CEA) is commonly used to manage postoperative pain in young infants. However, it can impair bladder function, leading to postoperative urinary retention (POUR) and necessitating Foley catheter placement, which carries a risk of urinary tract infection (UTI). Limited research exists on the frequency of POUR and UTIs and factors influencing optimal Foley catheter management in this population.
Methods:
A retrospective chart analysis conducted at UPMC Children's Hospital of Pittsburgh included 103 infants who had surgery with CEA. The patients were assigned to Group A (Foley catheter removed before epidural discontinuation), Group B (Foley catheter removed after epidural discontinuation), and Group C (no Foley catheter placement). Data collected included demographics, details regarding urinary complications, epidural analgesia, pain management, and Foley catheter management.
Results:
The median/IQR age was 8 weeks (0.71-13.29), and the weight was 3.01 (2.55-3.52) kg. POURs occurred shortly after surgery in two (1.9%) infants with no initial Foley catheter placement (p = 0.101). Two (1.9%) infants in Group B developed a UTI (p = 0.327). A total of 10 (9.7%) (Groups A and B) had a preexisting urologic condition (p = 0.040). Common surgeries included exploratory laparotomy with bowel resection (34%) and stoma closure (28.2%). The epidural catheter was discontinued on postoperative day 3 (median) (p = 0.587). Total opioid administration, median/IQR (MME mg/kg), was significantly higher in Group B (1.7/0.6-3.8) and Group A (0.7/0.3-1.8) compared to Group C (0.6/0.3-1.1) (p = 0.029).
Conclusions:
No POUR occurred when the Foley catheter was removed before the epidural was discontinued. UTIs occurred when the Foley catheter remained after epidural discontinuation. Our findings highlight the importance of individualized assessment for urinary catheter placement and early removal in young infants receiving CEA.
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