Department of Urology, Koru Hospital, Ankara, Turkey.
Urology. 2013 Sep;82(3):526-31. doi: 10.1016/j.urology.2013.02.083. Epub 2013 Jul 4.
To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL).
This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients.
The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P <.05). The VAS pain scores in patients with tubeless PCNL were significantly lower than those in patients with standard PCNL (P <.05).
The pain after tubeless and standard PCNL may be decreased by bupivacaine infiltration into the nephrostomy tract. The findings of the present study reveal that a tubeless procedure and local analgesic infiltration into the nephrostomy tract after the PCNL is the more comfortable procedure for the patients.
评估布比卡因经皮肾造瘘管注入在无管和标准经皮肾镜碎石术（PCNL）中的镇痛效果。
本前瞻性、随机对照研究纳入了 121 名患者。患者随机接受 PCNL 后经皮肾造瘘管内注入 20mL0.25%布比卡因。患者分为两组。第 1 组患者接受布比卡因浸润，而第 2 组患者不接受。术后 6、12 和 24 小时评估患者的视觉模拟量表（VAS）疼痛评分。根据患者要求，术后期间使用肌肉内双氯芬酸钠（75mg）或盐酸哌替啶（度冷丁）（50mg）缓解疼痛。
患者的平均年龄为 43.2±12.7 岁（范围 18-74 岁）。接受布比卡因浸润组的 VAS 疼痛评分在术后 6、12 和 24 小时以及需要的双氯芬酸钠量均显著低于未接受浸润组（P<.05）。无管 PCNL 患者的 VAS 疼痛评分明显低于标准 PCNL 患者（P<.05）。
经皮肾造瘘管内注入布比卡因可减轻无管和标准 PCNL 后的疼痛。本研究的结果表明，无管操作和 PCNL 后经皮肾造瘘管内局部镇痛浸润对患者更舒适。
