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

Kirac, Mustafa; Tepeler, Abdülkadir; Bozkurt, Ömer Faruk; Elbir, Fatih; Ozluk, Cem; Armağan, Abdullah; Ünsal, Ali; Biri, Hasan

doi:10.1016/j.urology.2013.02.083

Cited by 17 publications

(19 citation statements)

References 18 publications

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“…But Lojanapiwat et al [17] did not evaluate the pain status of patients at the 6th hour after the procedure. Pooling the data from the 2 studies [9,12] referred to VAS scores after 6 h showed no statistically significant difference between the experimental group and control group (WMD -1.79, 95% CI -3.64 to 0.05, p = 0.06; fig. 3c).…”

Section: Resultsmentioning

confidence: 97%

“…Finally, 5 RCTs [10,11,12,13,17] with 324 patients in the experimental group (local anesthetic infiltration group) and control group were included for meta-analysis and the random-effects model was used. Pooling data showed a significantly less consumption of analgesics after PCNL in the experimental group than in the control group (WMD -25.32, 95% CI -48.09 to -2.55, p = 0.003; fig.…”

Section: Resultsmentioning

confidence: 99%

“…The other 2 RCTs [12,13] did not refer to the analgesic demand time. The results of meta-analysis using the random effects model indicated that the time of first analgesic demand was significantly longer in the experimental group than in the control group (WMD 2.19, 95% CI 0.98-3.41, p < 0.0004; fig.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [9,12,17] evaluated the VAS score in the postoperative period. But Lojanapiwat et al [17] did not evaluate the pain status of patients at the 6th hour after the procedure.…”

Section: Resultsmentioning

confidence: 99%

“…As of now, the infiltration of local anesthetic into percutaneous tract for pain management is being applied by some urologists [9,10]. But the efficacy of local anesthetic infiltration around nephrostomy tract on postoperative pain control is still controversial [9,10,11,12,13]. However, we pooled the data of available studies to conduct a systematic review using meta-analysis to evaluate the role of local anesthetic infiltration around nephrostomy tract on postoperative pain control and determine whether anesthetic infiltration around nephrostomy tract is a better option.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Wang¹,

Zhang

Tan³

et al. 2016

Urol Int

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Objectives: To assess the safety and efficacy of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy. Methods: This systematic review was performed based on randomized clinic trials about local anesthetic infiltration around nephrostomy tract on postoperative pain control. The weighted mean difference (WMD), with their corresponding 95% CI, was calculated to compare continuous variables. Results: Our results showed that the consumption of analgesic was less in the experimental group than in the control group (WMD -25.32, 95% CI -48.09 to -2.55, p = 0.003). There was no significant difference between the mean Visual Analog Scale (VAS) in the experimental group than the control group after 6 h while significantly lower after 24 h. The time of first analgesic demand was significantly longer in the experimental group (WMD 2.19, 95% CI 0.98-3.41). There was no significant difference between 2 groups in terms of operation time, hemoglobin (Hb) alteration, and hospital stay. Conclusion: Local anesthetic infiltration around nephrostomy tract had similar efficacy in the control group in terms of operation time, Hb alteration, and hospital stay, but offers some potential advantages in terms of analgesia requirement, the time of first analgesic demand, and VAS-24 h. However, good quality and large studies with long-term follow-up are warranted for further research.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Three studies [9,12,17] evaluated the VAS score in the postoperative period. But Lojanapiwat et al [17] did not evaluate the pain status of patients at the 6th hour after the procedure.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Wang¹,

Zhang

Tan³

et al. 2016

Urol Int

View full text Add to dashboard Cite

show abstract

The effect of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy

2014

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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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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

et al. 2017

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Ketamine, as a systemic and local analgesic, has been used to reduce postoperative pain in many studies. The present study was designed to assess the analgesic efficacy of nephrostomy tract infiltration of ketamine in postoperative pain after tubeless percutaneous nephrolithotomy (PCNL). Sixty-six patients with renal stone who were candidates for PCNL were randomized to two groups with 33 patients in each group. In group K, 20 mL saline solution containing 1.5 mg/kg ketamine was infiltrated into the nephrostomy tract and in group C, 20 mL saline solution was infiltrated into the nephrostomy tract at the end of surgery. The postoperative pain scores, sedation scores, time to first rescue analgesia, rescue analgesic requirement, peak expiratory flow rate (PEF), and hemodynamic parameters were compared between two groups. Sixty-six patients with a mean age of 45.29 ± 15 years and an age range of 18-60 years participated in this study. There was no significant difference in the demographic data and duration of surgery between the two groups. The mean VAS scores were significantly lower in the intervention group compared with the control group at the recovery, and 4 and 6 h postoperatively (p = 0.001). The mean time to first rescue analgesia in the postoperative period was significantly lower in the control group (64.5 ± 8.1 min) compared with the intervention group (122 ± 18.4 min). The trend of first opioid administration was significantly lower in the ketamine group p < 0.009. There was no significant differences in PEF between the two groups in the postoperative period (p = 0.622). In conclusion infiltration of ketamine into the nephrostomy tract provides superior analgesic and sedative effects in PCNL surgery without significant changes in PEF.

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

Cited by 17 publications

References 18 publications

The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

The effect of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy

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

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