Effects of Analgesic and Anesthetic Medications on Lower Urinary Tract Function

Sammy E. Elsamra, MD; Pamela Ellsworth, MD, FAAP, FACS

Urol Nurs. 2012;32(2):60-67.

Conclusion

Commonly used anesthetic and analgesic agents can have predictable effects on the LUT system. A condensed summary of the effect of anesthetics and analgesics on the LUT has been provided in Table 1. Opioids, NSAIDS, and anesthetics all tend to result in increased risk of urinary retention, with intrathecal delivery resulting in the highest rates of POUR. Ketamine, an anesthetic of abuse, is associated with severe and irreversible LUT damage.

1 2 3 4 5 6 7 8

Next Section

Urologic Nursing Editorial Board Statements of Disclosure
In accordance with ANCC-COA governing rules Urologic Nursing Editorial Board statements of disclosure are published with each CNE offering. The statements of disclosure for this offering are published below.

Susanne A. Quallich, ANP-BC, NP-C, CUNP, disclosed that she is on the Consultants' Bureau for Coloplast.
All other Urologic Nursing Editorial Board members reported no actual or potential conflict of interest in relation to this continuing nursing education activity.

Table 1. Summary of Medications and the Effect on the Lower Urinary Ttract
Class of Medication	Risk of Urinary Retention	Mechanism of Effect on Lower Urinary Tract
Opiods	Increases	1. Decreases the sensation of bladder fullness by partially inhibiting the parasympathetic nerves that innervate the bladder. 2. Increase the tonus of the sphincter of the urinary bladder via sympathetic over-stimulation, resulting in increased resistance in the outflow tract from the bladder. 3. Intravenous morphine directly binds to spinal opioid receptors and causes total bladder relaxation rather than having targeted effects on the detrusor alone.
NSAIDs	Increases	Inhibit the production of PGE2. (PGE2 stimulates the release of tachykinins, which stimulate neurokinin receptors on afferent nerves and detrusor smooth muscle, and as a result, promote detrusor contraction.)
General Anesthetics	Increases	1. Smooth muscle relaxant. 2. Interfere with autonomic regulation of detrusor tone.
Neuraxial Anesthetics	Increases	1. Inhibition of the afferent and efferent fibers as they enter and exit the spinal cord (part of the micturition reflex arc). 2. Inhibition of the up-ward relaying of these signals to higher centers (PMC) within the spinal cord.
Ketamine	Decreases	Unclear mechanism; 80% with overactive bladder, causes irreversible irritative eosinophilic ulcerative cystitis.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.