Sharifi Seyed Hossein Hosseini, Soltani Mohammad Hossein, Rezaeetalab Gholam Hossein, Sharif Reyhaneh Yamini, Khaledi Flora, Lashay Alireza, Sharifiaghdas Farzaneh
Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, I.R. Iran .
J Endourol. 2014 Nov;28(11):1299-303. doi: 10.1089/end.2014.0408. Epub 2014 Aug 21.
Pain at the surgery site is a common complaint in patients who experience percutaneous nephrolithotomy (PCNL). The aim of this double-blind, randomized clinical trial is evaluation of the effect of scheduled infusion of bupivacaine on postsurgical pain and narcotic consumption after tubeless PCNL under spinal anesthesia.
Forty patients were randomly divided into two groups. A small caliber fenestrated feeding tube was placed into the nephrostomy tract under direct vision in a manner in which its tip lied close to the renal capsule. The study group received infusion of diluted bupivacaine while physiologic saline was injected in the control group. Each patient was given the same dose every 6 hours until 24 hours after the surgical procedure.
Mean pethidine injection was significantly lower in the group who underwent bupivacaine instillation (20.5±14.5 vs 3.97±2.4 mg: P=0.009). There was no significant difference between mean visual analogue scale (VAS) score in these two groups after 6 and 12 hours while it was significantly lower after 18 and 24 hours in the patients who had received bupivacaine. Mean time to the first analgesic request was significantly longer in the study group (11.35 vs 6.44 hours: P=0.001).
Intermittent perirenal instillation of bupivacaine via the nephrostomy tract after PCNL decreases the need for more systemic narcotics and provides acceptable analgesia in the postoperative period.
手术部位疼痛是接受经皮肾镜取石术（PCNL）患者的常见主诉。这项双盲随机临床试验的目的是评估在脊髓麻醉下行无管PCNL术后，定时输注布比卡因对术后疼痛及麻醉药物消耗的影响。
40例患者随机分为两组。在直视下将一根小口径带侧孔的喂养管置入肾造瘘通道，使其尖端靠近肾包膜。研究组接受稀释布比卡因输注，而对照组注射生理盐水。每位患者每6小时给予相同剂量，直至手术后24小时。
接受布比卡因滴注组的平均哌替啶注射量显著更低（20.5±14.5 vs 3.97±2.4mg：P = 0.009）。两组在6小时和12小时后的平均视觉模拟评分（VAS）无显著差异，但在接受布比卡因的患者中，18小时和24小时后的VAS评分显著更低。研究组首次镇痛需求的平均时间显著更长（11.35 vs 6.44小时：P = 0.001）。
PCNL术后经肾造瘘通道间歇性肾周滴注布比卡因可减少对更多全身性麻醉药物的需求，并在术后提供可接受的镇痛效果。
