The incidence of urinary retention during labor with two methods of epidural analgesia: an ultrasound-guided study

Abstract

508 09 THE INCIDENCE OF URINARY RETENTION DURING LABOR WITH TWO METHODS OF EPIDURAL ANALGESIA: AN ULTRASOUND-GUIDED STUDY SHMUEL EVRON, OSCAR SADAN, TIBERIU EZRI, wolfson medical center, anesthesia, holon, Israel wolfson medical center, obstetrics & gynecology, holon, Israel OBJECTIVE: We compared the incidence of urinary retention, with two methods of analgesia during labor. STUDY DESIGN:Onehundred laboring parturients who required epidural analgesia were equally allocated to receive either PCEA up to 20 ml/hour (5ml per bolus) 0.2 ropivacaine (Group R) or ropivacaine 0.2% up to 20ml/hour (5ml per bolus) with 2mcg fentanyl added to eachml of local anesthetic (Group RF). Variables assessed included: Visual analog scale (VAS) of pain sensory and motor levels and complications. Ultrasound measurements of the urinary bladder content volume were performed every hour. If the volume reached or exceeded 500 ml the urinary bladder was emptied and the urinary catheter was immediately removed. This assessment was continued up to 2 days following delivery by ultrasound measurement after each voiding. Also, urine samples were collected 2 days after delivery for urinalysis and culture. RESULTS: There were no significant differences with regard to total consumption of local anesthetics, level of motor and sensory block and complications related to epidural. In the RF group the VAS was 8+/-3 whereas in the R group was 17+/ 6 (P < 0.05). In the RF group 75% of the patients (with 500ml ormore of residual urine at US examination) required catheterization of the urinary bladder during labor compared with 52% (p < 0.05) in the R group. All women voided spontaneously between 4-8 hours after delivery. Most of the catheterizations (80%) were performed during labor, with the rest of them required within 8 hours after delivery. In the RF group 25% of the patients had positive urine cultures (Ecoli, Enterococus, Enterobacter, Klebsiella and Pseudomonas). In the R group 12% (p < 0.05) had positive urinary cultures for the same agents plus Beta-Hemolytic Streptococcus. CONCLUSION: Ropivacaine-fentanyl epidural provided better analgesia, required more catheterizations and had a higher incidence of positive urinary cultures. December 2003 Am J Obstet Gynecol S198 SMFM Abstracts