Indwelling urinary catheterization was unnecessary in non-drainage total knee arthroplasty: a randomized controlled tria
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KNEE ARTHROPLASTY
Indwelling urinary catheterization was unnecessary in non‑drainage total knee arthroplasty: a randomized controlled trial Satit Thiengwittayaporn1 · Pinyong Uthaitas1 · Natthapong Hongku1 · Revit Tunyasuwanakul1 · Ploynapas Limphunudom2 · Fontip Leelachiewchankul2 Received: 20 April 2020 / Accepted: 28 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate whether catheterization remains necessary in non-drainage total knee arthroplasty (TKA) using combined spinal epidural anesthesia (CSEA) with a short-acting opioid by comparing (1) incidences of postoperative urinary retention (POUR), and (2) postoperative clinical outcomes between retained urinary catheter (UC) and non-retained urinary catheter (non-UC) groups. Methods A total of 230 patients underwent non-drainage TKA using CSEA with fentanyl were randomized into UC and non-UC groups (115 patients each, 115 knees each). Incidences of POUR, clinical outcomes (intraoperative intravenous fluid, operative time, whole blood loss, urinary tract infection (UTI), and length of stay) were evaluated after the operation, while range of motion (ROM) and Knee society score (KSS) were evaluated 3- and 6-month postoperatively. Results Incidences of POUR and other perioperative and postoperative clinical outcomes between the two groups were not significantly different. ROM and KSS at 3- and 6-month postoperatively revealed no significant differences between the groups. Conclusion Given no significant difference in POUR incidence, clinical outcomes and knee scores and functions, catheterization in non-drainage TKA under CSEA with a short-acting opioid might not be necessary. Clinical Trials Clinical Trials gov (NCT03341819) (11/09/2017). Keywords Urinary catheterization · Non-drainage total knee arthroplasty · Combined spinal epidural anesthesia · Postoperative urinary retention · Short-acting opioid
Introduction The practice of perioperative and postoperative indwelling urinary catheterization, with removal at 1–2 days postoperatively, is still debatable in total knee arthroplasty (TKA) [1, 2]. While the practice has been routinely used in TKA, the use of catheters has been decreased in several countries [1, 3]. Indwelling urinary catheterization allows monitoring urinary output, guiding fluid resuscitation and supposedly * Satit Thiengwittayaporn [email protected] 1
Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit, Bangkok 10300, Thailand
Department of Anesthesiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit, Bangkok 10300, Thailand
2
preventing the risk of postoperative urinary retention (POUR) [2, 4]. POUR has been defined as an inability to voluntarily empty the bladder in the presence of a full bladder after anesthesia and surgery causing bladder overload [5]. It is associated with a risk of bladder overdistension, which may permanently impair detrusor function and there
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