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ANALGESIA

The Effects of Spinal Anesthesia with Lidocaine and Sufentanil on Lower Urinary Tract Functions

Ed T. Kamphuis, MD, PhD^*, Peter W. Kuipers, MD, Ger E. van Venrooij, PhD, and Cor J. Kalkman, MD, PhD

From the *Department of Anesthesiology, Rijnstate Ziekenhuis, Arnhem; Department of Anesthesiology, Gelre Ziekenhuizen, Apeldoorn; Departments of Urology (GE van Vanrooij former fellow); and Anesthesiology, University Medical Center, Utrecht, The Netherlands.

Address correspondence and reprint requests to Ed T. Kamphuis, MD, PhD, Department of Anesthesiology, Rijnstate Ziekenhuis, Postbus 9555, 6800 TA Arnhem, The Netherlands. Address e-mail to ed.kamphuis{at}planet.nl.

Abstract

BACKGROUND: Spinal local anesthetics interrupt the micturition reflex; bladder function remains impaired until sensory block had regressed to the S3 segment. Intrathecal opioids cause dose-dependent suppression of detrusor contractility. We studied the effects of spinal anesthesia with a combination of lidocaine and sufentanil on lower urinary tract function.

METHODS: Filling cystometry was performed in 10 healthy young male patients undergoing elective lower limb orthopedic surgery. After baseline recordings, each patient received spinal anesthesia with 100 mg hyperbaric lidocaine combined with 20 µg sufentanil. In the postoperative phase, regressions of sensory and motor block were recorded and urodynamic measurements continued until the patient could void spontaneously without residual volume in the bladder.

RESULTS: The mean (sd) time to recovery of urge was 240 (37) min after spinal injection, but no patient was able to void at that time. Six patients experienced urge at the previously observed maximum bladder capacity when the sensory block had regressed to the second sacral segment (S2), in four patients to S3. Despite this urge, no detrusor contraction was recorded. The patients were able to completely empty the bladder 332 (52) min after spinal injection. The average time difference between recovery of urge and return of normal bladder emptying was 90 min.

CONCLUSION: Bladder contractility returns much later than recovery of sensory function in sacral dermatomes (S3) when hyperbaric lidocaine combined with sufentanil is used for spinal anesthesia.