Ultrasound guided peritubal infiltration of 0.25% Bupivacaine versus 0.25% Ropivacaine for postoperative pain relief after percutaneous nephrolithotomy: A prospective double blind randomized study

Abstract

Background and Aim:Percutaneous nephrolithotomy (PCNL) is a common for managing renal calculi. Pain in the initial post operatie period is relieved by infiltration of local anaesthetic around the nephrostomy tract. We aimed to compare the analgesic efficacy of bupivacaine and ropivacaine.Methods:A total of 100 adult patients undergoing elective PCNL—under balanced general anaesthesia were randomly divided into bupivacaine group (Group B) and ropivacaine group (Group R). After completion of procedure, 23G spinal needle was inserted at 6 and 12 O’clock position under ultrasonic guidance up to renal capsule along the nephrostomy tube. A volume of 10 ml of either 0.25% bupivacaine or 0.25% ropivacaine solution was infiltrated in each tract while withdrawing the needle. Post-operative pain was assessed using visual analogue scale (VAS) and dynamic visual analogue scale (D-VAS) for initial 24 h. Intravenous tramadol was given as rescue analgesia when VAS >4. Time to first rescue analgesic, number of doses and total amount of tramadol required in initial 24 h and side-effects were noted.Results:Visual analogue scale and D-VAS at 6 h and 8 h in Group B was significantly higher than Group R. Mean time to first rescue analgesia in Group R was significantly longer than Group B. Mean number of doses of tramadol and total consumption of tramadol in 24 h was less in Group R, though not statistically significant.Conclusion:Peritubal infiltration of 0.25% ropivacaine infiltration along the nephrostomy tract is more effective than 0.25% bupivacaine in alleviating initial post-operative pain after PCNL.

Postoperative Analgesic Efficiency of Quadratus Lumborum Block Iii Versus Peritubal Local Infiltration in Patients Undergoing Percutaneous Nephrolithotomy Operation: A Randomized Controlled Trial

“…A two-sided P-value of <0.05 was considered statistically signi cant. P<0.01 was considered signi cant when multiple comparisons were performed for pain scores at rest and movement Previous studies detected a 40% difference in VAS score between the study groups, which is the primary outcome in our study [10,11], G* power computer program version 3.1.9.2 was used to calculate the sample size required with 80% power, an alpha error of 0.05 and allocation ratio of 1. [13] A sample size of 37 patients was calculated per group.…”

“…Ultrasound guided QL block has been described by Blanco as posterior extension of TAP Block to provide sensory block from T4-L2 [16]; later, it was used effectively by Sindwani et al [17]; to provide post laparoscopic nephrectomy. Peritubal or subcutaneous in ltration of the LA along the nephrostomy tube was used effectively as part of the PCNL postoperative analgesic strategy [10,18].…”

“…[11] In group (L), while the patient was still in the prone position, a spinal needle 22-gauge 2-inch Stimuplex A needle; B. Braun Medical Inc was inserted along the nephrostomy tube by the urologist under uoroscopy in the 6 and 12 o'clock positions, and the renal capsule was contacted. A total of 20 ml bupivacaine 0.25% was in ltrated along the renal capsule, muscle, subcutaneous tissue ,and the skin as described by Parikh et al [12]. In both, groups patients were turned to the supine position, and recovery from GA was performed with 2.5 mg neostigmine and 1 mg atropine to antagonize the action of the muscle relaxant.…”

“…It is known that local anesthetic (LA) deposition at the surgical site can suppress the local in ammatory response by directly inhibiting some phases of in ammation. Peritubal LA in ltration around the nephrostomy tube under uoroscopic guidance is one of the modalities that was developed to overcome the postoperative pain of PCNL, and it was proven to be effective in postoperative analgesia and decreasing the need for both oral and intravenous (IV) analgesics [10].…”

Effect of Epidural Analgesia in the Peri-Operative Haemodynamic Changes and Recovery Profile in Patients Undergoing Percutaneous Nephrolithotomy under General Anesthesia

“…Sensory block with Ropivacaine is similar to Bupivacaine (8) but Ropivacaine showed greater separation of sensory and motor block (9), (10) and better patient satisfaction (11) . Studies have also showed that Ropivacaine is effective for intraoperative and postoperative analgesia in patients undergoing PCNL (12), (13), (14) .…”