Efficacy of Peritubal Local Anesthetic Infiltration in Alleviating Postoperative Pain in Percutaneous Nephrolithotomy

Abstract

Percutaneous nephrolithotomy (PCNL) is a safe and effective endourologic procedure in patients with renal calculi. It is less morbid than open surgery. However, the patient complains of pain around the nephrostomy tube and demands for good postoperative analgesia. Skin infiltration with bupivacaine around the nephrostomy tube is not effective, so we hypothesize that peritubal infiltration of bupivacaine from renal capsule to the skin along the nephrostomy tract may alleviate postoperative pain. A randomized controlled study was designed in 40 American Society of Anesthesiologists (ASA) grade I patients to assess the impact of peritubal bupivacaine infiltration with 23-gauge spinal needle along the nephrostomy tract after PCNL under fluoroscopic guidance. Patients were randomized to receive 20 mL of 0.25% bupivacaine in block group (n = 20) or no infiltration in control group (n = 20) at the conclusion of the procedure. Postoperative pain score and analgesic requirement for the first 24 hours were assessed by visual and dynamic visual analog scales second hourly. Rescue analgesia with injection tramadol Hcl 50-100 mg was given intravenously to a maximum total dose of 400 mg when pain score exceeded 4. Pain scores and analgesic requirement for the first 24 hours postoperatively were significantly lesser in the block group than in the control group of patients at all points of time and were statistically significant (p < 0.005). In this study a significant difference in the pain scores and analgesic requirement was noted in the two groups of patients. Peritubal infiltration of 0.25% bupivacaine solution is efficient in alleviating postoperative pain after PCNL.