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Epidural anaesthesia and urinary dysfunction: the risks in total hip replacement

A Williams1, N Price, K Willett

  • 1Royal National Orthopaedic Hospital, Middlesex, England.

Journal of the Royal Society of Medicine
|December 1, 1995
PubMed
Summary
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Epidural anesthesia for hip replacement may increase urinary catheterization in men. This practice, while beneficial for pain relief, is linked to a higher incidence of catheter use, potentially raising infection risks.

Area of Science:

  • Anesthesiology
  • Orthopedic Surgery
  • Infectious Disease Prevention

Background:

  • Epidural anesthesia is a safe and established practice for total hip replacement, often combined with general anesthesia for pain management.
  • Perioperative urinary catheterization is a known risk factor for deep sepsis following total hip replacement surgery.

Purpose of the Study:

  • To assess the impact of bupivacaine epidural anesthesia, in addition to general anesthesia, on the incidence of urinary catheterization during total hip replacement.

Main Methods:

  • A prospective study was conducted involving 113 patients undergoing total hip replacement.
  • The incidence of urinary catheterization was compared between patients who received epidural anesthesia and those who did not.

Main Results:

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  • In male patients, the incidence of urinary catheterization was significantly higher (67%) in those receiving epidural anesthesia compared to those without (12%) (P = 0.001).
  • In female patients, the rates were 30% with epidural anesthesia versus 23% without, a less pronounced difference.

Conclusions:

  • Supplementary epidural anesthesia with bupivacaine in male patients undergoing total hip replacement is associated with a concerning increase in the need for urinary catheterization.
  • The potential benefits of epidural anesthesia must be carefully weighed against the increased risk of urinary catheterization and associated complications.