Efficacy of Levobupivacaine Infiltration to Nephrosthomy Tract in Combination with Intravenous Paracetamol on Postoperative Analgesia in Percutaneous Nephrolithotomy Patients

Abstract

To evaluate the efficacy of intraoperative local anesthetic infiltration in combination with intravenous paracetamol infusion on postoperative pain management in patients who underwent percutaneous nephrolithotomy (PCNL). Sixty adult patients were randomized into three groups with 20 cases in each: Group SP, 20 mL saline was infiltrated through the whole nephrostomy tract intraoperatively and this was followed by intravenous paracetamol (4 × 1 g) infusion postoperatively; group LP, 20 mL of 0.25% levobupivacaine infiltration to the nephrostomy tract followed by intravenous paracetamol infusion; Group LS, 20 mL of 0.25% levobupivacaine infiltration to the nephrostomy tract followed by intravenous saline infusion. In the postoperative period, the pain status of patients was evaluated at postoperative 6 and 24 hours by using the visual analogue scale (VAS). In patients who did not completely respond, meperidine (1 mg/kg intramuscularly) was administered as an additional "rescue" analgesic. Patient satisfaction from the postoperative analgesia management was assessed by a 5 point scale. There was no statistically significant difference between the three groups regarding the demographic characteristics, surgical complications, and postoperative hospital stay. Our findings revealed that in group LP, the amount and frequency of opioid used and related side effects was lesser, VAS score was lower, time to full mobilization was shorter, and the patient satisfaction score was higher when compared with the other two groups. Levobupivacaine infiltration through the nephrostomy tract in combination with intravenous paracetamol infusion was shown to be safe and efficacious as an analgesia method after PCNL.