None listed
Conditions
Brief summary
Objective: We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption through the patient-controlled analgesia (PCA) device in patients who underwent percutaneous nephrolithotomy combined with spinoepidural anesthesia. Material and Methods: Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL) in Group P (n=66), were infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue and skin with a 22G spinal needle under fluoroscopy. In Group C (n= 64), none of the patients received a peritubal injection. Postoperative pain control was achieved with epidural PCA. In first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands and postoperative complications were compared between groups. Results: The mean Visual Analog Scale (VAS) score at postoperative 8, 12, 24 h and dynamic VAS score at postoperative 4, 8, 12, 24 h were significant lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand (262.2 min) was significantly longer in Group P. Conclusion: Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption.
Interventions
All patients underwent spinoepidural anesthesia. The patients ' demographic data recorded. The patients were divided into two groups. Patients distributde to groups with closed envelope technique.
Group P (n=66): Peritubal infiltration group was given 0.25% bupivacaine [Bustesin(R), Vem, Ankara, Turkey] 20 mL + 5 mg morphine (0.5 ml) [Morphine HCl(R), Galen, Istanbul, Turkey] into the renal capsule, peripheral fat tissue, muscle tissue, subcutaneous tissues and skin after a nephrostomy tube was
All patients underwent spinoepidural anesthesia. The patients ' demographic data recorded. The patients were divided into two groups. Patients distributde to groups with closed envelope technique. Group P (n=66): Peritubal infiltration group was given 0.25% bupivacaine [Bustesin(R), Vem, Ankara, Turkey] 20 mL + 5 mg morphine (0.5 ml) [Morphine HCl(R), Galen, Istanbul, Turkey] into the renal capsule, peripheral fat tissue, muscle tissue, subcutaneous tissues and skin after a nephrostomy tube was inserted using a 22G spinal needle advanced towards 6 and 12 O’clock positions as guided by a fluoroscopy along nephrostomy catheter by urologist at the end of the surgery. The anesthetic solution was observed by fluoroscopy, which was evenly distributed throughout the nephrostomy catheter. Postoperative pain control was achieved with epidural patient-controlled analgesia (PCA)(CADD-Legacy(R) PCA, Smiths Medical, St Paul, USA) for the first 24 hours post surgery. Epidural PCA was prepared including 40 mL 0.5% bupivacaine + 500 mcg fentanyl + 110 mL 0.9% NaCl, to a total of 160 mL epidural solution as postoperative analgesic for all patients . Without a basal infusion, bolus dose was set as 5 mL, key duration as 20 min and hourly limit as 15 mL. In first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands and postoperative complications were compared between groups.
Sponsors
Isra Karaduman
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
-patients who underwent percutaneous nephrolithotomy - aged between 18 and 65 years, -whose the American Society of Anesthesiologists (ASA) score was I-III, -body mass index was <30 kg/m2, -stone size measured >2 cm, - duration of surgery was <3 h
Exclusion criteria
-allergic to local anesthetics or morphine, - patients having a contraindication to neuro-axial block, -patients given general anesthesia, - those with a bleeding disorder, -those having alcohol or substance abuse, -patients who underwent surgical interventions from multiple sites -patients who underwent bilateral PNL
Outcome results
None listed