Low-dose Spinal Bupivacaine decreases the Incidence of Postoperative Urinary Retention after Anorectal Surgery

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Thanyalak Thamjamrassri


 Background: Postoperative urinary retention is the most
common complication after anorectal surgery. A significant
risk factor for this complication is spinal anesthesia.
Objective: To compare postoperative urinary retention
after anorectal surgery under spinal anesthesia between
3 mg and 6 mg of 0.5% hyperbaric bupivacaine.
Methods: This study was approved by the Ramathibodi
Ethics Committee. Eighty patients undergoing surgical
treatment for hemorrhoids, anal fissures, anal fistulas,
or perianal abscesses were enrolled in this prospective
controlled trial and randomized into two groups: the
low-dose and conventional-dose groups. The patients
in the low-dose and conventional-dose groups received
spinal anesthesia with 3 mg and 6 mg of 0.5% hyperbaric
bupivacaine, respectively, and then sat for at least
5 minutes before positioning for the operation. During the
operation, patients were sedated with midazolam and/or
fentanyl if necessary. The primary outcome was incidence
of postoperative urinary retention.
Results: Data of all 80 patients were analyzed. Low-dose
spinal bupivacaine lowered the risk of urinary retention
from 32.5% to 7.5% (P = 0.005) (relative risk = 0.231, 95%
confidence interval = 0.071-0.748). The postoperative
morphine consumption during the first 24 hours
postoperatively were not significantly different between
the groups. Conclusions: Spinal anesthesia with 3 mg of 0.5%
hyperbaric bupivacaine provides adequate anesthesia
for surgery with a lower incidence of postoperative urinary

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Original articles


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