Doxapram Exposure Was Not Associated With Adverse Neurodevelopmental Outcomes in Very Low Birth Weight Infants: A Monocentric Retrospective Cohort Study.

Epidural analgesia is both safe and effective in pain management of children and adults after orthopedic surgery of the lower extremities and hips [, ]. However, epidural analgesia comes with an inherent risk of urinary retention and is often accompanied by placement of urinary catheters (UC), which are often left in place for the duration of epidural treatment [, ]. Our analysis, as well as others', have demonstrated that children after orthopedic surgery who received general anesthesia in conjunction with epidural analgesia had more frequent UC placement, longer duration of catheterization, and a higher frequency of ward insertions compared to those receiving general anesthesia alone [, ]. However, there are no clear guidelines regarding the indications for UC placement and optimal timing of their removal in these children. It is important to address this gap in knowledge in order to enhance patient recovery, including minimizing the occurrence of urinary retention, stress, discomfort, and possible urethral injuries associated with insertion of a UC while on the ward, and occurrence of urinary tract infection (UTI) associated with longer duration of UC use [, ]. We hypothesized that implementation of a standardized UC management protocol would significantly reduce the incidence of postoperative urinary retention requiring ward catheter insertion and reduce overall UC duration in children receiving epidural analgesia for pain control after surgery of the lower extremities or hips. Therefore, we developed and implemented a comprehensive institutional protocol regarding UC management, described below, designed to enhance recovery in these patients.