The Efficacy of Bupivacaine Infiltration on the Nephrostomy Tract in Tubeless and Standard Percutaneous Nephrolithotomy: A Prospective, Randomized, Multicenter Study

• DOI: 10.1016/j.urology.2013.02.083
• Publication Date: 2013-07-04T15:45:52Z
• Authors: Mustafa Kirac; Abdulkadir Tepeler; Omer Faruk Bozkurt; Fatih Elbir; Cem Ozluk; Abdullah Armagan; Ali Unsal; Hasan Biri
• Keywords: Adult; Male; Pain, Postoperative; Diclofenac; Time Factors; Adolescent; Meperidine; Middle Aged; Bupivacaine; 3. Good health; Analgesics, Opioid; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Cyclooxygenase Inhibitors; Female; Anesthetics, Local; Aged; Anesthesia, Local; Nephrostomy, Percutaneous; Pain Measurement

To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL).This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients.The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P <.05). The VAS pain scores in patients with tubeless PCNL were significantly lower than those in patients with standard PCNL (P <.05).The pain after tubeless and standard PCNL may be decreased by bupivacaine infiltration into the nephrostomy tract. The findings of the present study reveal that a tubeless procedure and local analgesic infiltration into the nephrostomy tract after the PCNL is the more comfortable procedure for the patients.