The effect of peritubal infiltration on postoperative analgesia in patients underwent percutaneous nephrolithotomy
İsra Karaduman1, Derya Karasu1, Canan Yılmaz1, Sedat Öner2, Hilal Erdem Solak1, Gülsen Korfalı1
1Anesteziyoloji ve Reanimasyon Kliniği, Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Bursa, Turkey
2Üroloji Kliniği, Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Bursa, Turkey
OBJECTIVE: In this study, we aimed to investigate, the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption via patient controlled analgesia (PCA) device, during postoperative 24 h, in patients underwent percutaneous nephrolithotomy (PNL) with combined spinoepidural (CSE) anesthesia. MATERIAL-METHODS: One hundered and thirty patients, aged 18-65 and with ASA physical status I-III were included in this study which was double blind, randomized trial. Patients were divided into two groups. All patiens underwent CSE anesthesia. In Group P patients (n= 66) 20 ml 25% bupivacaine + 5 mg morphine (0,5 ml) were infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue and skin with a 22 G spinal needle, at 6 O’clock and 12 O’clock positions under fluoroscopy. In Group C (n= 64) nobody had any peritubal injection. Postoperative pain control was achieved with epidural PCA. In first 24 h pain scores, time of the first analgesic demand, number of total analgesic doses and postoperative complications were compared between groups. RESULTS: The avarage Visual Analog Scale (VAS) score at postoperative 8., 12., 24. h and dynamic VAS score at postoperative 4.,8.,12.,24. h, were statistically significant lower in Group P. In Group P, patients’ analgesic demands (8.33 ± 8.8) and number of total analgesic doses (6.05 ± 5) were also significantly lower for first 24 h period. In addition, time of the first analgesic demand (262.2 ± 214.4 min) were statistically significant longer in Group P. In terms of peroperative and postoperative complications, there were not statistically significant difference between groups. CONCLUSION: Peritubal infiltration of bupivacaine with morphine after PNL is an effective method for postoperative pain control and reduces analgesic consumption.
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