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Gyawali S, Luitel BR, Bhattarai AS, Sharma UK. Comparison of efficacy of intercostal nerve block versus peritract infiltration with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial. Indian J Urol 2024; 40:37-43. [PMID: 38314072 PMCID: PMC10836456 DOI: 10.4103/iju.iju_276_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/01/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Postoperative pain following percutaneous nephrolithotomy (PCNL) adds to the morbidity of patients requiring additional analgesia. Various modalities of pain control techniques, such as intercostal nerve block (ICNB) and peritract infiltration (PTI), are being studied for better pain management. This study compares the efficacy of ICNB with PTI for postoperative pain management. Methods A double-blinded, prospective, randomized control study was conducted, in which 0.25% bupivacaine, either ICNB or PTI, was given at the puncture site at the end of PCNL. The primary outcome was a comparison of postoperative pain score measured with resting Visual analogue Scale (r-VAS) and dynamic VAS (D-VAS) recorded at 2 h, 4 h, 8 h, 10 h, 12 h, 24 h, and at discharge. Injection ketorolac was given as rescue analgesia. Secondary outcomes include time to first rescue analgesia and total analgesic requirement (TAR). Results Sixty patients were randomized into two equal groups with 63.3% male and 36.6% female, with a mean age of 37.25 ± 13.09 years. In Group ICNB, 24 (40%) and 6 (10%) patients and in Group PTI, 21 (35%) and 9 (15%) patients underwent standard and mini PCNL, respectively, in each group. All cases were PCNL doen in prone position. The mean R-VAS and D-VAS scores at 2, 4, 8, 12, 24, and 48 h were similar in both groups. The mean TAR was 56.84 ± 0.33.00 mg and 55.54 ± 0.29.64 mg of injection ketorolac in Group ICNB and PTI, respectively (P < 0.894). The time to first rescue analgesic demand were 7.11 ± 4.898 h and 6.25 ± 3.354 h (P < 0.527). Both the groups were comparable in terms of length of hospital stay, stone clearance rate, and complication rate. Conclusion The ICNB was as efficacious as PTI for postoperative pain control with 0.25% bupivacaine following PCNL.
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Affiliation(s)
- Sushil Gyawali
- Department of General Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhoj Raj Luitel
- Department of Urology and Kidney Transplant Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Amit Sharma Bhattarai
- Department of Anesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Uttam Kumar Sharma
- Department of Urology and Kidney Transplant Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Zheng C, Yang H, Yang L, Lv Y, Li Y, Luo J, Xiong B. Efficiency and safety of quadratus lumborum block in percutaneous nephrolithotomy: a meta-analysis of randomized controlled studies. Urolithiasis 2022; 51:12. [PMID: 36480122 DOI: 10.1007/s00240-022-01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022]
Abstract
To evaluate the effect of quadratus lumborum block (QLB) for postoperative analgesia after percutaneous nephrolithotomy (PCNL), we searched Pubmed, Embase, Cochrane library, the Chinese Biomedical Literature Database, and randomized controlled trials (RCTs) assessing analgesic efficacy of QLB for PCNL are included in this meta-analysis. The related trials met the inclusion criteria were analyzed using RevMan 5.4 software, the weighted mean difference (WMD), with their corresponding 95% CI, was calculated to compare continuous variables. Nine RCTs are included in the meta-analysis showed that QLB group had significantly lower opioids consumption (WMD - 29.59 95% CI - 43.64 to - 15.55; P < 0.00001), lessen visual analog scale (VAS) after surgery 2 h (WMD - 1.35, 95% CI - 1.93 to - 0.76; P < 0.00001), 6 h (WMD - 1.47, 95% CI - 2.04 to - 0.91; P < 0.00001) 12 h (WMD - 1.75, 95% CI - 3.17 to - 0.32; P = 0.02) and 24 h (WMD - 1.4, 95% CI - 1.86 to - 0.94; P < 0.00001), shorter hospital stay(WMD - 0.7, 95% CI -1.26 to - 0.14, P < 0.00001) and reduce intestinal exhaust recovery time (WMD - 7.41, 95% CI - 9.36 to - 5.46, P < 0.00001) than in the control group. QLB offers some potential advantages in terms of opioids consumption, VAS, hospital stay and intestinal exhaust recovery time. However, good quality and large studies with long-term follow-up are warranted for further research.
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Affiliation(s)
- Changjian Zheng
- Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Hongmei Yang
- Department of Rehabilitation, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China
| | - Lin Yang
- Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China
| | - Yalan Lv
- Department of School of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China
| | - Yu Li
- Department of Critical Care Medicine, The People's Hospital of Rongchang District, Chongqing, 402460, China
| | - Jun Luo
- Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China
| | - Bo Xiong
- Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China
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Gauhar V, Traxer O, García Rojo E, Scarcella S, Pavia MP, Chan VWS, Pretore E, Wroclawski ML, Corrales M, Tiong HY, Lim EJ, Teoh JYC, Heng CT, de la Rosette J, Somani BK, Castellani D. Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials. Urolithiasis 2022; 50:511-522. [PMID: 35674819 PMCID: PMC9468100 DOI: 10.1007/s00240-022-01337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/23/2022] [Indexed: 10/26/2022]
Abstract
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | - Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Simone Scarcella
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Pia Pavia
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Eugenio Pretore
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, BP-a Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Mariela Corrales
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | - Ho Yee Tiong
- Department of Urology, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, S.H. Ho Urology Centre, Hong Kong, China
| | - Chin-Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy.
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Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073625. [PMID: 33807296 PMCID: PMC8036507 DOI: 10.3390/ijerph18073625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022]
Abstract
Erector spinae plane block was recently introduced as an alternative to postoperative analgesia in surgical procedures including thoracoscopies and mastectomies. There are no clinical trials regarding erector spinae plane block in percutaneous nephrolithotomy. The aim of our study was to test the efficacy and safety of erector spinae plane block after percutaneous nephrolithotomy. We analyzed 68 patients, 34 of whom received erector spinae plane block. The average visual analogue scale score 24 h postoperatively was the primary endpoint. The secondary endpoints were nalbuphine consumption and the need for rescue analgesia. Safety measures included the mean arterial pressure, Ramsey scale score, and rate of nausea and vomiting. The visual analogue scale, blood pressure, and Ramsey scale were assessed simultaneously at 1, 2, 4, 6, 12, and 24 h postoperatively. The average visual analogue scale was 2.9 and 3 (p = 0.65) in groups 1 (experimental) and 2 (control), respectively. The visual analogue scale after 1 h postoperatively was significantly lower in the erector spinae plane block group (2.3 vs. 3.3; p = 0.01). The average nalbuphine consumption was the same in both groups (46 mL vs. 47.2 mL, p = 0.69). The need for rescue analgesia was insignificantly different in both groups (group 1, 29.4; group 2, 26.4%; p = 1). The mean arterial pressure was similar in both groups postoperatively (91.8 vs. 92.5 mmHg; p = 0.63). The rate of nausea and vomiting was insignificantly different between the groups (group 1, 17.6%; group 2, 14.7%; p = 1). The median Ramsey scale in all the measurements was two. Erector spinae plane block is an effective pain treatment after percutaneous nephrolithotomy but only for a very short postoperative period.
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Rangalakshmi S, Shankar K, Priyanka D, Kailash P, Deepak V. Comparison of peritubal infiltration and single level T10 paravertebral block in percutaneous nephrolithotomy (PCNL). J Anaesthesiol Clin Pharmacol 2021; 37:586-591. [PMID: 35340975 PMCID: PMC8944380 DOI: 10.4103/joacp.joacp_64_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Material and Methods: Results: Conclusion:
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Soni S, Parmar K, Charan SM, Sethi S, Naik NB. Peritubal Infiltration of Fentanyl Compared to Dexmedetomidine with Ropivacaine in Percutaneous Nephrolithotomy: A Randomized Comparative Analysis. Anesth Essays Res 2019; 13:1-6. [PMID: 31031471 PMCID: PMC6444944 DOI: 10.4103/aer.aer_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Dexmedetomidine has been found as an effective adjuvant in various nerve blocks. Despite several studies on dexmedetomidine with ropivacaine, there is no study on comparing with fentanyl in peritubal infiltration in percutaneous nephrolithotomy (PCNL). Aims: The aim of this study was to compare the effect of the addition of dexmedetomidine or fentanyl in peritubal local anesthetic infiltration on pain scores and analgesic consumption in patients who underwent PCNL. Settings and Design: This was a prospective, randomized, double-blind, tertiary care center-based study. Subjects and Methods: A total of 60 American Society of Anesthesiologists Class I, II, and III patients were selected and randomly divided into two groups: Group RF ropivacaine and fentanyl (n = 30) and Group RD ropivacaine and dexmedetomidine (n = 30). Balanced general anesthesia was given. After completion of the surgery, peritubal infiltration was given at 6 and 12 O’clock positions under fluoroscopic guidance. Postoperative pain was assessed using the visual analog scale and dynamic visual analog scale rating 0–10 for initial 48 h. Postoperative sedation was assessed using five-point sedation score. Time to first rescue analgesic, number of doses of tramadol, and total consumption of tramadol required in 48 h were noted. Statistical Analysis Used: Descriptive data were expressed in mean and standard deviation for between-group comparisons; the Chi-square and Fisher's exact tests were used for categorical variables, whereas t-test and Mann–Whitney U-test were used to compare continuous variables between two groups. Results: Duration of analgesia in group RD (12.87 ± 3.85) is more prolonged than group RF (8.13 ± 3.28) h. Total dose of rescue analgesia required in 48 h in group RF was higher as compared to group RD. Conclusions: Addition of dexmedetomidine to ropivacaine is more effective than fentanyl in terms of prolongation of analgesic efficacy of local anesthetic in peritubal block along with short-lived mild sedation.
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Affiliation(s)
- Sumit Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | | | | | - Sameer Sethi
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Naveen B Naik
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Singh I, Yadav OK, Gupta S. Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial. Urol Ann 2019; 11:363-368. [PMID: 31649454 PMCID: PMC6798289 DOI: 10.4103/ua.ua_141_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction and Aim: Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared. Materials and Methods: After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717. Results: Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien–Dindo classification) which were not statistically significant. Conclusion: Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.
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Affiliation(s)
- Iqbal Singh
- Division of Urology, Department of Surgery, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - Om Kumar Yadav
- Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sanjay Gupta
- Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, India
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Choi SW, Cho SJ, Moon HW, Lee KW, Lee SH, Hong SH, Choi YS, Bae WJ, Ha US, Hong SH, Lee JY, Kim SW, Cho HJ. Effect of Intercostal Nerve Block and Nephrostomy Tract Infiltration With Ropivacaine on Postoperative Pain Control After Tubeless Percutaneous Nephrolithotomy: A Prospective, Randomized, and Case-controlled Trial. Urology 2018; 114:49-55. [DOI: 10.1016/j.urology.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
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Tirtayasa PMW, Yuri P, Birowo P, Rasyid N. Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: A comprehensive review. Asian J Surg 2017; 40:419-423. [DOI: 10.1016/j.asjsur.2016.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/10/2016] [Accepted: 03/23/2016] [Indexed: 11/16/2022] Open
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The effect of nephrostomy tract infiltration of ketamine on postoperative pain and peak expiratory flow rate in patients undergoing tubeless percutaneous nephrolithotomy: a prospective randomized clinical trial. Urolithiasis 2017; 45:591-595. [DOI: 10.1007/s00240-017-0971-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
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Wang J, Zhang C, Tan D, Tan G, Yang B, Chen W, Tang G. The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. Urol Int 2016; 97:125-33. [DOI: 10.1159/000447306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022]
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Li C, Song C, Wang W, Song C, Kong X. Thoracic Paravertebral Block versus Epidural Anesthesia Combined with Moderate Sedation for Percutaneous Nephrolithotomy. Med Princ Pract 2016; 25:417-22. [PMID: 27265121 PMCID: PMC5588437 DOI: 10.1159/000447401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 06/05/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of thoracic paravertebral block (TPVB) for percutaneous nephrolithotomy (PCNL) in comparison with epidural anesthesia (EA) combined with moderate sedation. SUBJECTS AND METHODS One hundred American Society of Anesthesiologists (ASA) I-II adult patients scheduled for first-stage unilateral PCNL were randomly assigned to receive either TPVB or EA. All patients were given standard sedation and analgesia with propofol and sufentanil. Patient characteristics, surgical outcomes, anesthetic outcomes, and time to first use of a patient-controlled intravenous analgesic (PCIA) device and postoperative consumption of sufentanil in the first 24 h were recorded. Intergroup differences of the parameters were analyzed using an independent t test, Mann-Whitney test, and χ2 test as appropriate. RESULTS Patients who received TPVB consumed more propofol during ureteroscopy (56.2 ± 28.4 vs. 42.9 ± 27.5 mg, p < 0.05) and more sufentanil during ureteroscopy (9.7 ± 4.8 vs. 3.9 ± 2.7 μg, p < 0.05) and during PCNL (7.0 ± 4.3 vs. 1.9 ± 1.8 μg, p < 0.05) than those who received EA. The volume fluids infused in patients who received TPVB was less than in those who received EA (854 ± 362 vs. 1,320 ± 468 ml, p < 0.05). Time to first PCIA use, postoperative 24-hour consumption of sufentanil, and other parameters were comparable between groups. CONCLUSIONS In this study, TPVB was as effective and safe as EA in providing intraoperative anesthesia and postoperative analgesia for PCNL, although more sedatives and analgesics were used during PCNL in patients who received TPVB.
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Affiliation(s)
| | | | | | - Chengjun Song
- *Chengwei Song, Department of Anesthesiology, Jining No. 1 People's Hospital, Jining City, Shandong Province 272011 (PR China), E-Mail
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Sharifi SHH, Soltani MH, Rezaeetalab GH, Sharif RY, Khaledi F, Lashay A, Sharifiaghdas F. Intermittent perirenal instillation of bupivacaine after tubeless percutaneous nephrolithotomy under spinal anesthesia: a double-blind, placebo-controlled clinical trial. J Endourol 2014; 28:1299-303. [PMID: 24964217 DOI: 10.1089/end.2014.0408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Pain at the surgery site is a common complaint in patients who experience percutaneous nephrolithotomy (PCNL). The aim of this double-blind, randomized clinical trial is evaluation of the effect of scheduled infusion of bupivacaine on postsurgical pain and narcotic consumption after tubeless PCNL under spinal anesthesia. PATIENTS AND METHODS Forty patients were randomly divided into two groups. A small caliber fenestrated feeding tube was placed into the nephrostomy tract under direct vision in a manner in which its tip lied close to the renal capsule. The study group received infusion of diluted bupivacaine while physiologic saline was injected in the control group. Each patient was given the same dose every 6 hours until 24 hours after the surgical procedure. RESULTS Mean pethidine injection was significantly lower in the group who underwent bupivacaine instillation (20.5±14.5 vs 3.97±2.4 mg: P=0.009). There was no significant difference between mean visual analogue scale (VAS) score in these two groups after 6 and 12 hours while it was significantly lower after 18 and 24 hours in the patients who had received bupivacaine. Mean time to the first analgesic request was significantly longer in the study group (11.35 vs 6.44 hours: P=0.001). CONCLUSION Intermittent perirenal instillation of bupivacaine via the nephrostomy tract after PCNL decreases the need for more systemic narcotics and provides acceptable analgesia in the postoperative period.
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Affiliation(s)
- Seyed Hossein Hosseini Sharifi
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, I.R. Iran
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Tüzel E, Kızıltepe G, Akdoğan B. The effect of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy. Urolithiasis 2014; 42:353-8. [PMID: 24990067 DOI: 10.1007/s00240-014-0680-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/23/2014] [Indexed: 11/29/2022]
Abstract
The objective of the study was to investigate the effect of a long acting local anesthetic infiltration around nephrostomy tract on pain control after percutaneous nephrolithotomy. Forty-six patients with kidney stones of >2 cm undergoing single access subcostal percutaneous nephrolithotomy (PCNL) were enrolled in the study. Patients were randomized to levobupivacaine (Group I) and saline (Group II) infiltration groups. Group I patients (n = 23) had 75 mg/30 cc levobupivacaine infiltration around the access site after placement of nephrostomy catheter. Group II patients had 30 cc saline infiltration. Postoperatively the patients were given narcotics on demand. Pain scores were collected using a visual analog scale (VAS) at 2, 4, 6, 8, 12 and 24 h postoperatively. The VAS scores, time to analgesic demand, ambulation, and duration of nephrostomy tube were compared between two groups. The mean age was 44 and 45 years in group I and II patients. There were no significant differences between the two groups with regard to demographics, surgery or stone characteristics. Comparison of pain scores at all postoperative time points was not statistically significant between the two groups. Time to first analgesic demand and total narcotic analgesic dose per patient were 1.2 ± 1.05 and 4.04 ± 1.57 h; and 96 and 112 mg for group I and II patients (p = 0.009 and p = 0.41, respectively). Ambulation time and duration of nephrostomy tube were also similar. Infiltration of nephrostomy tract site with levobupivacaine does not have a superior effect compared to saline on postoperative pain control in patients undergoing PCNL.To prolong analgesia, the effect of intermittent tract injections or continuous infusion of local anesthetics for the postoperative maintenance of the local anesthetic effect seems worth to investigate in future studies.
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Affiliation(s)
- Emre Tüzel
- Department of Urology, Baskent University Zübeyde Hanim Practice and Research Center, İzmir, Turkey,
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Lightfoot M, Ng C, Engebretsen S, Wallner C, Huang G, Li R, Alsyouf M, Olgin G, Smith JC, Baldwin DD. Analgesic use and complications following upper pole access for percutaneous nephrolithotomy. J Endourol 2014; 28:909-14. [PMID: 24548123 DOI: 10.1089/end.2014.0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Upper pole access (UPA) to the kidney optimizes working angles during percutaneous nephrolithotomy (PCNL). However, many surgeons are hesitant to employ UPA due to concerns for increased postoperative pain and complications. In this study, we compare perioperative pain and outcomes for PCNL performed through UPA with middle and lower pole access (LPA). METHODS A retrospective review of PCNLs performed at a single academic institution between 2002 and 2012 was performed. Patient demographics, stone burden, operative characteristics, length of hospital stay, and perioperative complications were recorded. Narcotics administered on postoperative days (POD) 1 and 2 were converted to intravenous morphine equivalents. The Mann-Whitney U, Fisher's exact test, and logistic regression analyses were used for statistical comparison. RESULTS Of 350 PCNLs performed on 269 patients, 125 patients underwent primary PCNL through single tract UPA, while primary LPA was utilized in 138 patients. Patients with multiple access tracts (n=6) were excluded. Baseline characteristics between groups were similar except for age; patients with UPA were older (52.6 vs. 46.2 years; p=0.003). Stone burden, operative time, and initial stone-free rate were comparable between groups. Additionally, analgesic requirements were similar on POD 1 (p=0.54) and 2 (p=0.62). There was no difference in the overall complications (p=0.23) or thoracic complications (p=0.43). Although both groups had equivalent stone-free rates after initial PCNL (p=0.78), those with residual stones had a superior stone-free rate after second-look PCNL through UPA (73.3% vs. 44.3%, p=0.035) and a superior overall stone-free rate (94.4% vs. 86.2%, p=0.037). CONCLUSIONS Patients undergoing PCNL through UPA had a higher ultimate stone-free rate compared with LPA, while postoperative analgesic requirements and overall complication rates were similar between access sites. A trend toward higher thoracic complication rates was observed in the UPA group, although this did not reach statistical significance. Surgeons should not hesitate to utilize UPA when indicated for patients with large or complex stones.
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Affiliation(s)
- Michelle Lightfoot
- 1 Department of Urology, Loma Linda University School of Medicine , Loma Linda, California
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