Postoperative Intravenous Ketorolac Significantly Reduces the Risk of Acute Urinary Retention Requiring Catheterization in Benign Anal Surgery

對於肛門良性疾病手術，術後施打經靜脈克多炎（Ketorolac）能顯著降低急性尿滯留需放置導尿管的風險

林陳彥(Chen-Yan Lin) ； 陳周斌(Chou-Pin Chen) ； 陳周誠(Chou-Chen Chen) ； 蔣鋒帆(Feng-Fan Chiang) ； 林俊余(Chun-Yu Lin) ； 陳明正(Ming-Cheng Chen)

《中華民國大腸直腸外科醫學會雜誌》 32卷4期 (2021/12) Pp. 168-173

https://doi.org/10.6312/SCRSTW.202112_32(4).11016

摘要

Purpose. Urinary retention is a common complication after anal surgery, but it can be mainly prevented by fluid restriction and adequate pain control. Despite these strategies, nonsteroidal anti-inflammatory agents (NSAIDs) are more widely accepted because of the availability of parenteral ketorolac. The pain control effect of intravenous (IV) ketorolac has been widely described. However, its influence on postoperative catheterization has not been addressed. Methods. A total of 116 patients who were subjected to benign anal surgery by a single surgeon (Ming-Cheng Chen.) were identified over a period of 1.5 years. Data on surgery type, anesthetic method, IV ketorolac (15 mg every 6 h), pain control agents, catheterization, time needed for surgery, elective or emergent surgery were collected. Results. Of the total patients, 47 (40.52%) received regular IV ketorolac, 69 (59.48%) did not receive IV ketorolac. Of the 47 patients who received IV ketorolac, 3 (6.38%) required catheterization. This value was significantly lower than that in the non-IV ketorolac group, i.e., 16 of 69 (23.19%; p = 0.032). We found a significant overall association between IV ketorolac group and catheterization with an odds ratio of 0.174 (95% Cl 0.035-0.871, p = 0.033). However, anesthesia type, surgery type, elective or emergent surgery had no significant associations. Conclusions. Postoperative intravenous ketorolac may reduce the risk of acute urinary retention requiring catheterization in benign anal surgery. More data and a longer follow-up period are still needed to identify the possible complications, such as gastrointestinal bleeding or renal injury.

關鍵字

Anal surgery ； IV ketorolac ； Acute urinary retention ； Catheterization

並列摘要

目的：急性尿滯留為肛門手術常見之併發症，且限水與疼痛控制能有效降低此風險。非類固醇消炎藥（NSAIDs）之中，可由靜脈給予的克多炎（Ketorolac）逐漸被廣泛的使用。有不少文章討論靜脈給予之非類固醇消炎藥用於肛門手術止痛的效果，但鮮少研究提及其與置放尿管的關聯性。方法：我們蒐集了台中榮民總醫院過去一年半中，由單一外科醫師（陳明正）執行之良性肛門疾病手術病人共116位。資料來源根據病歷紀載，蒐集了關於手術種類，麻醉方式，是否使用靜脈克多炎（每6小時15毫克），術後口服止痛藥物種類，置放尿管，手術時間，常規手術或急診手術。結果：總共47位病人（40.52%）接受術後靜脈克多炎，69位病人（59.48%）沒有施打。在有施打克多炎的病人中，只有3位需要置放導尿管（6.38%），統計上顯著比沒施打組的少（23.19%, p = 0.032），調整後的勝算比為0.174（95%信賴區間0.035-0.871, p =0.033）。而手術種類，麻醉方式，常規手術或急診手術則沒有統計上的差異。結論：肛門良性疾病術後常規給予經靜脈克多炎，能降低急性尿滯留需置放導尿管之風險。在未來，我們需要更多的病人資料以及更長的追蹤時間來評估這些可能的副作用。

並列關鍵字

肛門手術 ； 經靜脈克多炎 ； 急性尿滯留 ； 尿管置放

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