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OBJECTIVES: To see the effect of bupivacaine infiltration of nephrostomytract in reducing the postoperative pain and analgesic requirements inpatients undergoing percutaneous nephrolithotomy.METHODOLOGY: This randomized controlled study was conductedat institute of kidney diseases Hayatabad Medical Complex, Peshawar,Pakistan, from June 1, 2011 to May 31, 2012. Total 66 patients (33 patientsin each group) were included in the study through consecutivenon-probability sampling technique and were randomly divided intogroup A (bupivacaine, 33 patients) and group B (placebo, 33 patients).RESULTS: Mean age was 32.2+2.7 & 31.09+2.6 years in group A & Brespectively. The mean duration of the procedure was 70.66±7.41 &72.12±.65 minutes for group A & B respectively. The overall averagepain score for group A was 4.15±1.48 on visual analogue scale, whilethat for group B was 6.06±1.02 (p < 0.05). The average pain score forfemale patient was 4.07, (range 2-7) & 6.13 (range 4-8) in group A & Brespectively. The average pain score for male patient was 4.12 (range2-7) & 6.0 (range 4-7) in group A & B respectively. The effect of ageon pain perception was not significant in this study as we included onlyadult patients (≥14 years of age) and mixed response was observed inboth groups patients of different age groups.CONCLUSION: Preoperative bupivacaine infiltration of the nephrostomytract is safe and an effective way of reducing the postoperative painand analgesic requirements avoiding the adverse effects of the opioidsor non-opioids analgesics.
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Lal M. Management of stone diseases:
17 years experience of stone clinic in a
developing country. J Pak Med Associate
2009; 29: 843-6.
2. Haleblian GE, Roger LS, Albala DM,
Preminger GM. Subcutaneous Bupivacaine
infiltration and postoperative pain perception
after percutaneous nephrolithotomy.
J Urol 2007; 178: 925-8.
3. Agrawal MS, Agrawal M, Gupta A, Bansal
S, Yadav A, Goyal J. A randomized comparison
of tubeless and standard percutaneous
nephrolithotomy. J Endourol 2008;
4. Lingeman JE, Matlaga BR, Evan AP. Surgical
management of upper urinary tract
calculi. In: Wein AJ, Kavoussi LR, Novick
AC, Partin AW, Peters CA, editors. Campbell-
Walsh UROLOGY. Ninth edition. New
York: Saunders, Elsevier:2007. P2662-6.
5. Wezel F, Mamoulakis C, Rioja J, Michel MS,
de la Rosette J, Alken P. Two contemporary
series of percutaneous tract dilation for
percutaneous nephrolithotomy. J Endourol
2009; 23: 1655-61.
6. Falahatkar S, Moghaddam AA, Salehi M,
Nikpour S, Esmaili F, Khaki N. Complete
supine percutaneous nephrolithotripsy
comparison with the prone standard
technique. J Endourol 2008; 22: 2513-7.
7. Jonnavithula N, Pisapati MV, Durga P,
Krishnamurthy V, Chilumu R, Reddy B.
Efficacy of peritubal local anesthetic infiltration
in alleviating postoperative pain in
percutaneous nephrolithotomy. J Endourol
2009; 23: 857-60.
8. Ansaloni L, Agnoletti V, Bettini D, Caira
A, Calli M, Catena F, et al. The analgesic
efficacy of continuous elastomeric pump
ropivacaine wound instillation after appendectomy.
J Clin Anaesth 2007; 19: 256-63.
9. Gupta A. Local anaesthesia for pain relief
after laparoscopic cholecystectomy- A systemic
review. Best Practice and research.
Clin Anesthesiol 2005; 19: 275-91.
10. Drasner K. Local Anaesthetics. Katzung B,
Masters S, Trevor A, authors. Katzung basic
and clinical pharmacology. 12th edition.
LANGE Basic Science: 2012; P449-52.
11. Shah HN, Sodha HS, Khandkar AA,
Kharodawala S, Hegde SS, Bansal MB. A
randomized trial evaluating type of nephrostomy
drainage after percutaneous
nephrolithotomy: Small bore v tubeless.
J Endourol 2008; 22: 1433-9.
12. Grape S, Tramèr MR. Do we need preemptive
analgesia for the treatment of
postoperative pain? Best Pract Res Clin
Anaesthesiol 2007; 21: 51-63.
13. Falahatkar S, Panahandeh Z, Saurati A.
Percutaneous nephrolithotomy vs open
surgery for patients with renal staghorn
stones. Uro TodayInt J 2009; 2: 131-9.
14. Snyder JA, Smith AD, Staghorn calculi:
percutaneous extraction versus anatrophic
nephrolithotomy. J Urol 1986; 136: 351-4.
15. Rawal N. Incisional and intra-articular
infusions. Best Pract Res Clin Anaesthesiol
2002; 16: 321-43.
16. Rawal N. Analgesia for day-case surgery.
Br J Anaesth 2001; 87: 73-87.
17. Yndgaard S, Holst P, Bjerre-Jepsen K,
Thomsen CB, Struckmann J, Mogensen
T. Subcutaneously versus subfascially
administered lidocaine in pain treatment
after inguinal herniotomy. Anesth Analg
1994; 79: 324-7.
18. Chester JF, Ravindranath K, White BD,
Shanahan D, Taylor RS, Lloyd-Williams
K. Wound perfusion with bupivacaine:
objective evidence for efficacy in postoperative
pain relief. Ann R Coll Surg Engl
1989; 71: 394-6.
19. Gupta A, Thorn SE, Axelsson K. Postinjections of 0.5% ropivacaine through a
catheter after laparoscopic cholecystectomy.
Anesth Analg 2002; 95: 450-6.
20. Mecklem DW, Humphrey MD, Hicks RW.
Efficacy of bupivacaine delivered by wound
catheter for post–caesarean section analgesia.
Aust N Z J Obstet Gynaecol 1995;
21. Zohar E, Fredman B, Phillipov A, Jedeikin
R, Shapiro A. The analgesic efficacy of patient-
controlled bupivacaine wound instillation
after total abdominal hysterectomy
with bilateral salpingo-oophorectomy.
Anesth Analg 2001; 93: 482-7.
22. Pietrow PK, Auge BK, Lallas CD, Santa-
Cruz RW, Newman GE, Albala DM,
Preminger GM. Pain after percutaneous
nephrolithotomy: impact of nephrostomy
tube size. J Endourol 2003; 17: 411-4.
23. Ugra MY, Toprak HI, Gunen H, Yucel A,
Gunes A. Instillation of skin, nephrostomy
tract, and renal puncture site with
ropivacaine decreases pain and improves
ventilatory function after percutaneous
nephrolithotomy. J Endourol 2007; 21:
24. Gill P, Kiani S, Victoria BA, Atcheson R.
Pre-emptive analgesia with local anaesthetic
for herniorrhaphy. Anaesthesia
2001; 56: 414-7.
25. Goodarzi M. The effect of perioperative
and postoperative caudal block on pain
control in children. Paediatr Anaesth
1996; 6: 475-7.
26. Gurbet A, Bekar A, Bilgin H, Korfali
G, Yilmazlar S, Tercan M. Pre-emptive
infiltration of levobupivacaine is superior
to at-closure administration in lumbar
laminectomy patients. Eur Spine J 2008;
27. Sajedi P, Yaraghi A, Zadeh MTD. Comparison
of pre- vs. post-incisional caudal
bupivacaine for postoperative analgesia
in unilateral pediatric herniorrhaphy: A
double-blind randomized clinical trial.
Saudi J Anaesth 2011; 5: 157-61.
28. Takada M, Fukusaki M, Terao Y. Postoperative
analgesic effect of preoperative
intravenous flurbiprofen in arthroscopic
rotator cuff repair. J Anesth 2009; 23:
29. Grube JO, Milad MP, Damme-Sorenen J.
Preemptive analgesia does not reduce pain
or improve postoperative functioning. J
Soc Laparoendoscopic Surg 2004; 8: 15-8.