Caudal Anesthesia and Urinary Retention in Ambulatory Surgery

To the Editor: Voiding intervals in children receiving caudal anesthesia are variable, but urinary retention requiring therapeutic intervention has not been reported [1,2]. Caudal anesthesia is, however, frequently implicated when urinary retention occurs after discharge. To determine the incidence of voiding difficulties and the contribution of perioperative factors, a retrospective survey of the post-operative course of 326 children (<12 yr) undergoing urological surgery and inguinal herniorrhaphy was conducted. Data were collected from anesthesia records, recovery room data sheets, and quality assurance data sheets designed to monitor recovery 24 h after discharge. Recorded variables were demographics, type and duration of surgery, local anesthetic drug and adjunct (epinephrine), type of analgesia-caudal versus local anesthetic infiltration, use of autonomic drugs (atropine, reversal drugs), amount of intravenous fluids, and postoperative voiding difficulties. Caudal anesthesia was administered to 237 children, and local anesthesia was administered to 63 children. Twenty-six children who did not undergo either of the two analgesic techniques were excluded. The study variables were comparable between the two groups. Bupivacaine 0.25% was used in all cases. Postoperative voiding difficulties were identified in seven children (9-22 h after discharge), five (2%) in the caudal group and two (3%) in the local group. Urinary retention (bladder distension and dribbling) requiring invasive intervention (catheterization/suprapubic drainage) occurred predominately in children undergoing hypospadias repair; four (6%) children required such intervention. In comparison, only 1 of the 233 children who underwent other surgical procedures required invasive intervention (single catheterization) for urinary retention (P < 0.01). Although commonly implicated, caudal anesthesia was found to have no correlation with the incidence of postoperative urinary retention in this retrospective study. There was, however, a distinct correlation between urinary retention and type of surgery, with patients undergoing hypospadias repair having the highest incidence of urinary retention requiring therapeutic intervention. Ana Lucia S. Pappas, MD* Radha Sukhani, MD* David Hatch, MD** Departments of *Anesthesiology and **Urology; Maywood, IL 60153