The role of local anesthesia to reduce pain after PСNL

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

The goal of the study was to assess the level of postoperative pain in patients undergoing PCNL after paratubal infiltration with local anesthetic to compare this method of anesthesia with a control group where local anesthesia was not provided. 63 patients were included with kidney stones, confirmed by computer tomography (CT), who were planned to undergo percutaneous nephrolithitomy (PСNL). During the observation 6 patients have been excluded in accordance with the exclusion criteria. The remaining 57 patients were randomized into 2 groups: group A (n= 28) at the end of the operation received paratubal infiltration of 0.5% sol. ropivacaine; group B (n= 29) (controls) — local anesthesia was not used. Postoperative pain was assessed by means of VAS-score 1 hour, 6 hours and 24 hours after surgery. Systemic analgesia was performed with NSAIDs (intramuscular injection of 100 mg ketoprofen) when requested by the patient (Patient-Controlled Analgesia). In patients with local anesthesia, the total VAS score evaluated after 1 and 6 hours after the operation was significantly lower than in the control group. The average amount of ketoprofen required for postoperative analgesia in the group of patients with paratubal infiltration was significantly lower than in the control group. Paratubal infiltration of local anesthetic after PCNL significantly reduced postoperative pain and tended to reduce the amount of NSAIDs to eliminate pain, which in turn may reduce the risk of complications associated with NSAID.

Full Text

Restricted Access

About the authors

Sergei V Popov

St Petersburg St Luka Clinical Hospital

Author for correspondence.
Email: doc.popov@gmail.com
MD, PhD, Dr. Med. Sci., Head Doctor Russian Federation

Igor N Orlov

St Petersburg St Luka Clinical Hospital

Email: doc.orlov@gmail.com
urologist, MD, PhD. Director of urologic department Russian Federation

Vladimir M Obidnyak

St Petersburg St Luka Clinical Hospital

Email: v.obidniak@gmail.com
MD, urologist. Department of Urology Russian Federation

Sergey M Malevich

St Petersburg St Luka Clinical Hospital

Email: malevichsm@gmail.com
MD, urologist. Department of Urology Russian Federation

Maxim V Borichev

St Petersburg St Luka Clinical Hospital

Email: medmaxx3@bk.ru
MD, urologist. Department of Urology Russian Federation

Stanislav M Basok

St Petersburg St Luka Clinical Hospital

Email: stas_basok@mail.ru
MD, urologist. Department of Urology Russian Federation

Nariman K Gadzhiev

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: nariman.gadjiev@gmail.com
urologist, MD, PhD. Department of Urology Russian Federation

Nair S Tagirov

St Petersburg St Elisabeth City Hospital

Email: ruslana73nair@mail.ru
MD, PhD, urologist Russian Federation

Alexey V Pisarev

St Petersburg Multiprofile Center, Ministry of Health of Russian Federation

Email: alexey.v.pisarev@gmail.com
MD, urologist, Department of Urology Russian Federation

Vigen A Malkhasyan

Moscow State Medical Stomatological University named after A.I. Evdokimov

Email: vigenmalkhasyan@gmail.com
urologist, MD, PhD. Department of Urology Russian Federation

Denis A Mazurenko

Urologic Clinic EMC

Email: d.a.mazurenko@gmail.com
urologist, MD, PhD. Vice Director of Urologic Clinic Russian Federation

References

  1. Григорьев Н.А., Семенякин И.В., Гаджиев Н.К., и др. Мочекаменная болезнь // Урология. – 2016. – № 52. – С. 37–69. [Grigorev NA, Semenyakin IV, Gadzhiev NK, et al. Mochekamennaya bolezn. Urologiya. 2016;(52):37-69. (In Russ.)]
  2. Хасигов А.В., Белоусов И.И., Коган М.И. Сравнительный анализ эффективности и безопасности нефролитотомии при коралловидных камнях // Урология. – 2013. – № 1. – С. 86–88. [Hasigov AV, Belousov II, Kogan MI. Comparative assessment of percutaneous nephrolitotomia effectiveness in case of corral-like stones. Urologiya. 2013;(1):86-88. (In Russ.)]
  3. Ak K, et al. Thoracic paravertebral block for postoperative pain management in percutaneous nephrolithotomy patients: a randomized controlled clinical trial. Medical principles and practice. International Journal of the Kuwait University, Health Science Centre. 2013;22(3):229-33.
  4. Desai Mahesh R, et al. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. The Journal of Urology. 2004;172(2):565-67. doi: 10.1097/01.ju.0000130752.97414.c8.
  5. Fernström I, Johansson B. Percutaneous Pyelolithotomy. A new extraction technique. Scandinavian Journal of Urology and Nephrology. 1976;10(3):257-59.
  6. Gadsen J. Local anesthetics for peripheral nerve block. The New York School of Regional Anesthesia. 2013.
  7. Honey R, et al. A randomized, double-blinded, placebo-controlled trial of intercostal nerve block after percutaneous nephrolithotomy. Journal of Endourology. 2013;27(4):415-19. doi: 10.1089/end.2012.0418.
  8. Jonnavithula Nirmala, et al. Efficacy of Peritubal Local Anesthetic Infiltration in Alleviating postoperative pain in percutaneous nephrolithotomy. Journal of Endourology. Endourological Society. 2009;23(5):857-60. doi: 10.1089/end.2008.0634.
  9. Joshi Girish P. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiology Clinics of North America. 2005:23(1):185-202. doi: 10.1016/j.atc.2004.11.010.
  10. Kim Samuel C, William W. Tinmouth, Ramsay L. Kuo. Using and choosing a nephrostomy tube after percutaneous nephrolithotomy for large or complex stone disease: a treatment strategy. Journal of Endourology. Endourological Society. 2005;19(3):348-52. doi: 10.1089/end.2005.19.348.
  11. Patel Sutchin R, Stephen Y. Nakada. The modern history and evolution of percutaneous nephrolithotomy. Journal of Endourology. Endourological Society. 2015;29(2):153-57. doi: 10.1089/end.2014.0287.
  12. Shen Pengfei, Yong Liu, Jia Wang. Nephrostomy tube-free versus nephrostomy tube for renal drainage after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urologia Internationalis. 2012;88(3):298-306. doi: 10.1159/000332151.
  13. Türk Christian, et al. EAU guidelines on interventional treatment for urolithiasis. European Urology. 2016;69(3):475-82. doi: 10.1016/j.eururo.2015.07.041.
  14. Ugras Murat Yahya, Huseyin Ilksen Toprak, Hakan Gunen, et al. Instillation of skin, nephrostomy tract, and renal puncture site with ropivacaine decreases pain and improves ventilatory function after percutaneous nephrolithotomy. Journal of Endourology. Endourological Society. 2007;21(5):499-503. doi: 10.1089/end.2006.0335.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016 Popov S.V., Orlov I.N., Obidnyak V.M., Malevich S.M., Borichev M.V., Basok S.M., Gadzhiev N.K., Tagirov N.S., Pisarev A.V., Malkhasyan V.A., Mazurenko D.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 69634 от 15.03.2021 г.