Objectives: Percutaneous nephrolithotomy and placement of nephrostomy tube are performed for renal stones >2 cm in diameter. Attempts have been made to infiltrate local anesthetics with or without adjuvants into the surgical site to reduce pain. We hypothesized that there would be a significant prolongation of the analgesic effect of local anesthetic instillation along the nephrostomy tube due to the adjuvant dexamethasone. Methods: After ethical approval and Clinical Trials Registry -India registration (CTRI/ 2020/03/024332), 64 American Society of Anesthesiologists classification 1 and 2 adult patients were enrolled in this randomized double-blinded prospective study divided into Group R-received 20 mL 0.2% Ropivacaine and Group R + D-received 20 mL 0.2% Ropivacaine with dexamethasone 8 mg, injected through a multi-lumen wound infiltration catheter.Results: The demographic profile of patients was similar in both groups. The mean duration of analgesia was longer in Group R + D (21.3 AE 2.1 hrs) versus Group R (10 AE 1.9 hrs, P = 0.001). The mean numeric rating scale scores of Group R + D were significantly lower at all time intervals (P = 0.001). Also, the cumulative dose of ropivacaine and the total use of fentanyl postoperatively in Group R was much higher (70 AE 10.4 vs 56 AE 8.9 μg, P = 0.02). The C-reactive protein levels were significantly lower in Group R + D (13.8 AE 1.5 vs 23.1 AE 1.2 mg/L, P = 0.001 and 16.5 AE 1.3 vs 28.5 AE 1.7 mg/L, P = 0.001, at 24 and 48 hrs, respectively). Conclusion:We conclude that dexamethasone can be used as a suitable adjuvant to intermittent local anesthetic infiltration after percutaneous nephrolithotomy with a nephrostomy tube for the prolongation of analgesia.
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