대한대장항문학회

Introduction : Urinary retention (UR) is one most common complication of anal surgery and<br>its cause is multifactorial. Postdural puncture headache (PDPH) is caused by cerebrospinal<br>fluid leakage after spinal anesthesia, therefore it may be aggravated by early ambulation.<br>Purpose : To determine whether early ambulation (EA) vs. bed rest (BR) reduces the<br>incidence of UR after anal surgery under spinal anesthesia, without causing PDPH. Methods<br>: In this prospective, randomized study, 107 patients undergoing anal surgery under spinal<br>anesthesia were randomly assigned in the EA group (n=54) or the BR group (n=53). UR was<br>defined as a voiding difficulty that needs catheterization. In the BR group, the patients were<br>positioned flat in bed on the operation day. Anesthetic techniques (tetracaine injection using<br>24-gauge needle in sitting position, bupivacaine local infiltration) and postoperative pain<br>therapy (intramuscular demerol injection every 6 hours, oral nonsteriodal antiinflammatory<br>drug plus acetaminophen) were standardized. Perioperative intravenous fluids were restricted.<br>Results : Urinary retention and PDPH occurred in 32 (29.9%) and 7 (6.5%) patients,<br>respectively. UR was significantly reduced in the EA group (10/54=18.5%) vs. the BR group<br>(22/53=41.5%) (p=0.017, Chi-square). The incidence of PDPH, however, was not different<br>between the two groups (5.6% in the EA vs. 7.5% in the BR group). Conclusions : Early<br>ambulation has important implication on reducing the incidence of urinary retention after anal<br>surgery under spinal anesthesia, without causing PDPH.<br>