Prospective Observational Study to Evaluate Post‐Operative Urinary Retention With Pediatric Epidural Analgesia

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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.

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