Outpatients Do Not Need to Void after Short Neuraxial Blocks
Bibliographic record
Abstract
We thank Dr. Mulroy for his comments on voiding requirement in outpatients receiving neuraxial blockade with short-acting local anesthetic. We would like to take the opportunity to clarify some issues raised by Dr. Mulroy.In our review,1we identified several risk factors for postoperative urinary retention (POUR), such as type and duration of surgery, patient comorbidities, intraoperative fluid management, and choice of anesthetic and analgesic technique.In the setting of ambulatory surgery, we proposed an algorithm based in part on two previous studies by Pavlin et al. 2,3In the first study, patients were stratified before surgery in high and low risk for POUR. Patients who had a past history of urinary retention and those who underwent anorectal and inguinal hernia repair surgery were considered at high risk, even if they did not receive either spinal or epidural anesthesia. In the second study,327% of the patients who received neuraxial anesthesia with local anesthetic (bupivacaine or lidocaine ± epinephrine) were unable to void and had a bladder volume greater than 600 ml, thus requiring in-and-out bladder catheterization. These patients were identified by Pavlin et al. as high risk only because they received neuraxial anesthesia. However, in our opinion, the high incidence of POUR in this group was not caused by the use of spinal–epidural anesthesia per se , but by the use of long-acting local anesthetics. Mulroy et al. ,4in contrast, studied 46 patients without risk factors for POUR who received spinal or epidural anesthesia with short-acting local anesthetic with or without intrathecal fentanyl and who were discharged without voiding. None of them returned to the hospital because of POUR.The aim of our review was to bring to the attention of anesthesiologists the perioperative risk factors for POUR, and propose an algorithm on how to manage urinary retention judiciously. We agree with Dr. Mulroy that in outpatients with no risk factors for POUR, neuraxial anesthesia with short-acting local anesthetic does not increase the risk of POUR, and patients can be discharged home without voiding. However, in patients with preoperative risk factors for POUR, neuraxial anesthesia with short-acting local anesthetic may or may not further increase the risk, but the availability of a perioperative algorithm that includes the use of a bladder scan could facilitate the management of this potential complication.*McGill University Health Centre, Montreal, Canada. franco.carli@mcgill.ca
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".