MP63-15 DOES SIZE MATTER? PAIN SCORES AND NARCOTIC USAGE AMONGST SHEATH SIZES IN AMBULATORY PERCUTANEOUS NEPHROLITHOTOMY (PCNL) PROCEDURES

Abstract

INTRODUCTION AND OBJECTIVE: Smaller PCNL tracts are becoming popular due to an increasing ability to clear even large stones as well as decreasing tissue trauma. We postulate that smaller tracts may decrease post-operative pain and narcotic usage in the post-anesthesia care unit (PACU). METHODS: All mini-PCNL (mPCNL, n=32) and standard tract PCNLs (sPCNL, n=67) performed by a single surgeon at an ambulatory surgery center within the last 6 months were analyzed. mPCNL procedures were performed with a 16.5/17.5 French dilator/sheath metal set. sPCNL procedures were performed with a 24/28-30/34 French sheath with balloon dilation. Patient demographics, stone characteristics, and operative room (OR) times were recorded. Pain scores (Numerical Rating Scale, 0-10) on arrival, 15, 60 minutes, and at discharge were recorded. Aldrete scores (Oxygenation, Respiration, Circulation, Consciousness, Activity scores ranked 0-2 for a total score from 0-10) after surgery were recorded. Post-operative PACU morphine equivalents were tracked. RESULTS: mPCNL patients tended to be younger (51 vs 57, p=0.04), had lower stone burdens (17.5 vs 36.4 mm, p=0.0001), and shorter procedures (OR time 84 vs 93, p=0.03 and intracorporeal time 36 vs 44 min, p=0.04). Despite this, mPCNL patients tended to have higher pain scores at 15 (1.78 vs 0.7, p=0.04) and 60 minutes (2.56 vs 1.33, p=0.03). This was not correlated with changes in Aldrete scores or PACU time. Finally, PACU morphine equivalent usage was almost triple in the mPCNL cohort (2.94 vs 1.03, p=0.02). CONCLUSIONS: mPCNL patients tended to have higher pain scores and require higher doses of narcotics in the PACU. Plans for a prospective matched study with single step metal dilation vs balloon dilation are underway. Increased intra-renal pressures are known to occur in mPCNL procedures; however, it is not clear if these increased pressures account for the increased need for pain control or if the dilation technique (metal dilation for mPCNL versus radial dilation for sPCNL) contribute to the increased pain noted post-procedure.Source of Funding: NA