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Prospective Observational Study to Evaluate Post-Operative Urinary Retention With Pediatric Epidural Analgesia
Ashish Sam Samuel1, Jujju Jacob Kurian1, Anita Shirley Joselyn2
1Department of Pediatric Surgery, Christian Medical College, Vellore, India.
Insights
Post-operative urinary retention (POUR) affects 10.2% of children receiving epidural analgesia, with older children and longer surgeries increasing risk. This suggests an age-guided approach to catheterization in pediatric epidural practice.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Urology
Background:
- Epidural analgesia is effective for pediatric post-operative pain.
- Post-operative urinary retention (POUR) significantly impacts recovery.
- Limited data exists on POUR in children receiving epidural analgesia.
Purpose of the Study:
- To investigate the incidence and risk factors of post-operative urinary retention (POUR) in children undergoing epidural analgesia.
- To address the data gap regarding POUR in pediatric patients receiving epidural pain management.
Main Methods:
- Prospective study in a pediatric surgery department.
- 157 children received epidural analgesia (Ropivacaine or Bupivacaine) during and after surgery.
- Ultrasound identified urinary retention, followed by catheterization if needed.
Main Results:
- Overall POUR incidence was 10.2% (16/157 children).
- Incidence increased with age (12.8% in ≥2 years vs. 0% in <2 years) and surgical duration.
- No significant difference in POUR based on opioid additives, anesthetic agent, or epidural level.
Conclusions:
- POUR incidence rises with age in pediatric patients receiving epidural analgesia.
- An age-guided, selective approach to bladder catheterization is recommended.
- Larger prospective studies are needed to establish evidence-based thresholds for catheterization.
Background And Objectives:
Epidural analgesia is an effective analgesic method for children throughout the postoperative phase. The post-operative urinary retention affects the post-operative recovery immensely. Many studies look at post-operative urinary retention in adults who receive epidural analgesia, while there is a paucity of data in children. This is a study that addresses the question of post-operative urinary retention in children in whom epidural analgesia is employed.
Methodology:
This is a prospective study undertaken in the pediatric surgery department of Christian Medical College in Vellore. Children enrolled in the trial got epidural analgesia both during and after surgery. They weren't catheterized before the surgery. Those who had urinary retention were identified with ultrasound and were catheterized. Data were prospectively collected and analyzed.
Results:
A total of 157 children participated in this study. Epidural bolus and infusate were either Ropivacaine or Bupivacaine. Sixteen children developed post-operative urinary retention, yielding an overall incidence of 10.2%. Children who were below 2 years of age had no postoperative urinary retention (95% CI: 0.0%-10.9%). Those aged 2 years and above had an incidence of 12.8% (95% CI: 8.0%-19.8%). The likelihood of voiding is 1.15 times higher in children under the age of 2 than in those 2 years and above (Relative Risk (RR): 1.15, 95% CI: 1.07 to 1.23). The incidence of POUR was 13.2% in girls and 7.9% in boys (RR: 1.68, 95% CI: 0.66-4.29, p = 0.270). POUR was observed by 9.6% of the group without the opioid additive and 11.1% of the group with the opioid additive (RR: 0.862, 95% CI: 0.338-2.19). The rate of POUR increased with surgical duration, from 6.1% in procedures < 120 min to 10.8% in procedures with 120 to 180 min and 16.0% in those exceeding 180 min. The bolus used at induction, the Bupivacaine group had 13 out of 124 patients (10.5%) with POUR, and the Ropivacaine group had 3 out of 33 patients (9.1%) with POUR (RR: 1.15, 95% CI: 0.349 to 3.81). The level of epidural placement was not found to be a significant predictor in this study.
Conclusion:
This study found a rising trend in POUR incidence with age, signifying that older children are more likely to have POUR. This supports a selective, age-guided approach to bladder catheterization in pediatric epidural practice, though larger prospective studies are needed to establish evidence-based thresholds.
