Background

The incidence of acute urinary retention (AUR) in children receiving intravenous (IV) opioids varies widely. Risk factors have been studied scarcely.

Objectives

To determine the incidence, risk factors and the time to event of AUR in children receiving IV opioids.

Methods

Prospective observational study at the Amsterdam UMC, The Netherlands, from January-November 2018. This is an interim-analysis.

Included were children 0-18 year admitted to a general ward or pediatric intensive care unit (PICU), receiving IV opioids >4h. Exclusion criteria: indication for IUC, per-operative AUR, urological pathology, epidural/ spinal/ caudal anaesthesia, neuro-muscle disease, receiving paralysing agents, prematurity.

AUR was defined as the inability to void >8h, with a bladder volume larger than expected for age, confirmed by ultrasound.

Univariable and multivariable logistic regression analysis were performed to study the association between potential risk factors and AUR.

Results

We included 207 participants, of which 31(15.0%) developed AUR, with 19/65(29.2%) in PICU and 12/142(8.5%) in non-PICU patients.

In univariable analysis PICU admission, sedation as indication for opioids, reason for admission and maximum daily fluid intake were significantly associated with AUR. After stepwise backward selection, PICU admission (adjusted OR=4.40,95%CI:1.75-11.19,p=0.002) and maximum daily fluid intake (10% deviation of normal intake, adjusted OR=0.78,95%CI:0.65-0.90,p=0.002) remained significantly associated.

Median time to AUR was 9h (IQR:7.14-13.3), 28/31(90,3%) occurred <24h.

Conclusion

Our preliminary results indicate that routinely IUC placement is not required in children receiving IV opioids, if strict observation of voiding and any necessary US and IUC placement is performed, which is at greatest importance in PICU patients and during the first 24h.