The efficacy of peritubal analgesic infiltration in postoperative pain following percutaneous nephrolithotomy - A prospective randomized controlled study

Bannakij Lojanapiwat, Tanarit Chureemas, Pruit Kittirattarakarn, Bannakij Lojanapiwat, Tanarit Chureemas, Pruit Kittirattarakarn

Abstract

Objective: To study the efficacy of peritubal infiltration in postoperative pain following percutaneous nephrolithotomy in general PCNL patients and PCNL patients with supracostal renal access.

Patients and methods: A total of 105 PCNL patients were randomized into two groups, 53 patients receiving peritubal analgesic infiltration (study group) and 52 patients as the control group. Of these patients, supracostal access was performed in 22 patients of study group and 23 patients of control group. The study group received peritubal injection with 10mL of bupivacain. Postoperative pain as the primary outcome was assessed by using visual analogue scale at 1, 4, 12, 24 and 48 hours postoperatively. The secondary outcomes were the total postoperative morphine usage in 24 hours and time of the first analgesic demand.

Results: The average VAS pain at 1 and 4 hours after the operation in the study group were significant lower in the control group (P≤ 0.001 and 0.026). Doses of morphine usage for controlling postoperative pain and the first analgesic demand were significantly lower and longer in study group. Among patients submitted to supracostal access, the average VAS pain at 1 hour after operation in the study group was lower (P=0.018). Doses of morphine usage for controlling postoperative pain also was lower in the study group (P=0.012).

Conclusion: The peritubal local anesthetic infiltration is effective in alleviating immediate postoperative pain after percutaneous nephrolithotomy even with supracostal access.

Conflict of interest statement

CONFLICT OF INTEREST

None declared.

Figures

Figure 1. Intraoperative fluoroscopic view of peritubal…
Figure 1. Intraoperative fluoroscopic view of peritubal injection.
Figure 2. Visual Analog Score at postoperative…
Figure 2. Visual Analog Score at postoperative times of 1, 4, 12, 24, 48 hours (total patients).
Figure 3. Visual Analog Score at postoperative…
Figure 3. Visual Analog Score at postoperative times of 1, 4, 12, 24, 48 hours (supracostal patients).

References

    1. Ugras MY, Toprak HI, Gunen H, Yucel A, Gunes A. Instillation of skin, nephrostomy tract, and renal puncture site with ropivacaine decreases pain and improves ventilatory function after percutaneous nephrolithotomy. J Endourol. 2007;21:499–503.
    1. Pietrow PK, Auge BK, Lallas CD, Santa-Cruz RW, Newman GE, Albala DM, et al. Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol. 2003;17:411–414.
    1. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth. 2005;94:505–513.
    1. Bektas F, Eken C, Karadeniz O, Goksu E, Cubuk M, Cete Y. Intravenous paracetamol or morphine for the treatment of renal colic: a randomized, placebo-controlled trial. Ann Emerg Med. 2009;54:568–574.
    1. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology. 2005;102:822–831.
    1. Memis D, Inal MT, Kavalci G, Sezer A, Sut N. Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. J Crit Care. 2010;25:458–462.
    1. Desai MR, Kukreja RA, Desai MM, Mhaskar SS, Wani KA, Patel SH, et al. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol. 2004;172:565–567.
    1. Bellman GC, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L. Tubeless percutaneous renal surgery. J Urol. 1997;157:1578–1582.
    1. Lojanapiwat B. Does previous open nephrolithotomy affect the efficacy and safety of tubeless percutaneous nephrolithotomy? Urol Int. 2010;85:42–46.
    1. Parikh GP, Shah VR, Modi MP, Chauhan NC. The analgesic efficacy of peritubal infiltration of 0.25% bupivacaine in percutaneous nephrolithotomy-A prospective randomized study. J Anaesthesiol Clin Pharmacol. 2011;27:481–484.
    1. Haleblian GE, Sur RL, Albala DM, Preminger GM. Subcutaneous bupivacaine infiltration and postoperative pain perception after percutaneous nephrolithotomy. J Urol. 2007;178:925–928.
    1. Jonnavithula N, Pisapati MV, Durga P, Krishnamurthy V, Chilumu R, Reddy B. Efficacy of peritubal local anesthetic infiltration in alleviating postoperative pain in percutaneous nephrolithotomy. J Endourol. 2009;23:857–860.
    1. Schug SA, Manopas A. Update on the role of non-opioids for postoperative pain treatment. Best Pract Res Clin Anaesthesiol. 2007;21:15–30.
    1. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93:1123–1133.
    1. Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85:808–816. Erratum in: Anesth Analg 1997;85:986.
    1. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111:52–58.
    1. Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg. 2003;97:1464–1468.
    1. Maghsoudi R, Tabatabai M, Radfar MH, Movasagi G, Etemadian M, Shati M, et al. Opioid-sparing effect of intravenous paracetamol after percutaneous nephrolithotomy: a double-blind randomized controlled trial. J Endourol. 2014;28:23–27.
    1. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101:S5–22.
    1. Hsu GL, Ling PY, Hsieh CH, Wang CJ, Chen CW, Wen HS, et al. Outpatient varicocelectomy performed under local anesthesia. Asian J Androl. 2005;7:439–444.
    1. Ng A, Swami A, Smith G, Davidson AC, Emembolu J. The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy. Anesth Analg. 2002;95:158–162.
    1. Pobereskin LH, Sneyd JR. Wound infiltration with bupivacaine after surgery to the cervical spine using a posterior approach. Br J Anaesth. 2000;84:87–88.
    1. Wright JE. Controlled trial of wound infiltration with bupivacaine for postoperative pain relief after appendicectomy in children. Br J Surg. 1993;80:110–111.

Source: PubMed

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