Anesthésie neuroaxiale et fonction vésicale

The impact of neuraxial techniques and substances upon the function of bladder is still subject of debate. Local anaesthetics block the bladder function as well as the urge to void, but also adjuvant substances may further accentuate these effects. For epidural techniques, an indwelling catheter is generally accepted, but there is still discussion about if and how long these catheters should remain in place. Monitoring bladder volume with catheterization when necessary seems acceptable for several procedures. In spinal anaesthesia for outpatients, recovery of bladder function may be more challenging as, for longer-lasting surgery in hospitalized patients, the threshold to place an indwelling catheter is lower. Voiding delay in day-case setting may also affect the duration of the hospital stay and have economical consequences. Although voiding may no longer be considered as an absolute discharge milestone for all outpatients, it might be worthwhile to consider that recovery of the detrusor function can be influenced by local anaesthetic choice, neuraxial adjuvants and anaesthetic technique. Short-acting local anaesthetics seem most suitable, but also long acting local anaesthetics in a lower dose have been used. Adding opioids or clonidine do not seem to have any advantage in terms of discharge times or micturition and are subject to more side effects. As there is no consensus whether a unilateral technique may have less influence on bladder function, more studies are required. Last but not least, fluid policy should be balanced between a liberal one with the risk of early bladder filling and otherwise fluid restriction with drawbacks as well.