The objective of this study is to compare the incidence of postoperative urinary retention
related to spinal anesthesia with morphine and spinal anesthesia associated with peripheral
blockade in orthopedic procedures of lower limbs. Secondary objectives are assessing the
incidence of nausea and vomiting; postoperative pain and opioid consumption at 24 hours after
surgery with each of the techniques. A total of 52 patients submitted to a lower limb
orthopedic procedure were randomized to the intervention groups: spinal anesthesia with
morphine versus spinal anesthesia without opioid associated with peripheral nerve block.
After surgery, bladder ultrasound will be performed in post-anesthesia care unit to identify
urinary retention and patients will be followed for 24 hours to assess outcomes.

The participants were hospitalized in Orthopedic and Traumatology Departments in Military
Institute of Medicine, Warsaw, Poland.

The inclusion criteria were (1) age to 40 year-old, (2) no history of urologic problems, and
(3) surgery under spinal anesthesia. All the patients where (1) opioids were administered
during the surgery, (2) general anesthesia was necessary, and (3) the urinary bladder
catheterization was perform during the surgery were excluded from the study.

The participants were randomly divided into the study and control groups. No oral
premedication was administered. All the patients were asked to empty their urinary bladders
before arrival to the operating theatre. When the standard monitoring (continuous
electrocardiogram, noninvasive blood pressure, pulse oximetry) was started, intravenous
premedication with midazolam was administered and lumbar spinal anesthesia with hyperbaric
0.5% solution of bupivacaine hydrochloride was performed.

In the study group, but not in the the control one, the 40 mg of drotaverine hydrochloride
was administered intramuscularly. The decresed intravascular volume was corrected with
cristalloids. During the surgery the adequate, not deeper than II grade according to Ramsay
scale, level of sedationt was obtained with midazolam and/or propofol. All the participants
received a questionaire in which we asked the questions about (1) the duration of anesthesia,
(2) the time of micturition, (3) the time when discomfort or pain appeared in the lower
abdomen, (4) the incidence of the urinary bladder catheterization and time to
catheterization. On the next day after the surgery the questionaires were collected. In
cases, when the patient’s dischaged from the hospital was planned during the weekend, he or
she was asked to pass on the questionaire to the nurses.