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Bladder Function in Spinal Anaesthesia
Author(s) -
Axelsson K.,
Möllefors K.,
Olsson J. O.,
Lingårdh G.,
Widman B.
Publication year - 1985
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1985.tb02207.x
Subject(s) - medicine , cystometry , bupivacaine , anesthesia , detrusor muscle , spinal anesthesia , urination , tetracaine , reflex , urinary bladder , motor block , urology , surgery , anatomy , urinary system , lidocaine
Spinal anaesthesia with bupivacaine (22.5 mg) or with a glucose‐containing solution of bupivacaine (20 mg) or tetracaine (15 mg) was given to 21 patients allocated randomly to these three groups. A urodynamic study was performed by CO 2 cystometry. It consisted of recording of first sensation of bladder filling, sensation of full bladder, strength of maximal detrusor contraction, bladder capacity and urethral pressure. At the same time, using a quantitative method for measuring muscle strength, the motor block was evaluated for three separate movements ‐ hip flexion, knee extension and plantar flexion of the big toe. After the spinal injection, the micturition reflex was rapidly blocked. One minute after the injection, eight patients experienced no strong desire to void when the bladder was overfilled, and 5 min after the injection bladder paralysis was present in most patients. The length of time from spinal injection to complete recovery of detrusor strength was 7–8 h and did not differ significantly between the three groups. The level of analgesia lay at or caudal to L5 when the detrusor strength returned. On the average, sensibility (pin‐prick) in the sacral segments returned simultaneously with or somewhat earlier than complete recovery of detrusor strength. The muscle strength in the lower limbs was fully restored 40–140 min, on average, before the detrusor strength had completely recovered. There was good correlation between the time of full restoration of hip flexion and detrusor strength in the bupivacaine groups. Urethral pressure was reduced by a mean of 48% and returned to normal either at the same time as or slightly before complete recovery of detrusor strength. The urine production during spinal anaesthesia with routine fluid therapy (ca. 300 ml/h) was so great that if the patient had not been catheterized there would have been a risk of over‐distension of the bladder. This should be kept in mind in patients receiving spinal anaesthesia with local anaesthetics that give motor block of long duration.