Patients’ satisfaction with sedoanalgesia versus subarachnoid analgesia in endourology

AbstractObjectiveIn this study the effectiveness and safety of sedoanalgesia technique compared to spinal anesthesia in endourology procedure as well as patients’ satisfaction was assessed.Patients and methodsA prospective randomized study was performed in 80 adult patients, ASA I, II, and III who underwent various endoscopic procedures randomly allocated into two groups 40 patients each: Sedoanalgesia group, received local anesthesia (2% lignocaine gel), i.v. midazolam incremental doses 0.015mg/kg on demand, and i.v. fentanyl 2μg/kg, and 0.5μg/kg on demand interaoperative, and Spinal anesthesia group received 2.5ml heavy bupivacaine 0.5% to achieve around T10 level. We recorded vital parameters, and the number of cases with hemodynamic, respiratory complications, nausea and vomiting, and conversion to general anesthesia (failure). Postoperatively the intensity of pain (VAS 0-100mm), time to first analgesic request (VAS ⩾30), patient satisfaction (complete, partial or not satisfied) and time to readiness for discharge were assessed.ResultsThere was no significant difference in intra, postoperative hemodynamic changes and complications between groups but hypotension was more frequent in Spinal group. Immediate postoperative, there was no significant difference in pain score between groups, but 1 and 2h postoperatively there were higher pain scores in Sedoanalgesia group. Time to first analgesic request and readiness for discharge were significantly less in Sedoanalgesia group, but the difference was not significant as regard satisfaction scores.ConclusionSedoanalgesia is an effective, safe and simple alternative to Spinal anesthesia for endourology, with good patients’ satisfaction and less time to discharge

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies