Sandhu J S, Singh Ajit K, Bhatulkar Abhijit, Pratap Uday, Chauhan Milind
Senior Advisor (Surgery & Urology), Command Hospital (Eastern Command), Kolkata 700027, India.
Senior Advisor (Anesthesia & Critical Care), Base Hospital, Delhi Cantt 110001, India.
Med J Armed Forces India. 2019 Apr;75(2):204-210. doi: 10.1016/j.mjafi.2018.11.002. Epub 2019 Jan 11.
Ureteroscopic management of ureteral calculi using topical anaesthesia has been described. Most studies topically anaesthetized the urethra or urinary bladder by instilling 2% of plain lignocaine. In addition to the success rate, the pain perception in these studies was reported subjectively using non-standard criteria. Topical anaesthesia of the ipsilateral ureter and the pelvicalyceal system (PCS), in addition to urethra and urinary bladder, and use of alkalinised lignocaine, for enhanced effect, has not been reported for ureteroscopy. Using these conceptual alterations, we tested the safety and efficacy of performing ureteroscopy and laser lithotripsy under our technique of total intraluminal topical anaesthesia (TILTA).
One hundred sixty-eight patients underwent ureteroscopic laser lithotripsy by topical instillation of alkalinised lignocaine into the urinary bladder and ipsilateral ureter and PCS. Self-assessed pain perception and changes in vital parameters were objectively scored at various times. The success rate, reasons for failure, maximum pain scores, complications, and willingness to undergo repeat procedure were recorded.
The success rate was 91.3% with a mean duration of 14.7 minutes Double J Stent (DJS) was placed in 38.1%. 61.3% patients did not need any postoperative injectable analgesic, with 11.3% requiring more than a single dose. The intraoperative changes in vitals initially and at the height of pain were not statistically significant (p>0.05). Self-assessed median pain scores between intravenous access placement and ureteroscopy were significantly different (p<0.05).
Ureteroscopy, effectively performed under TILTA, is safe with a high success rate. The acceptable pain tolerance and the shortened convalescence in addition makes the procedure's success worth the pain.
已有关于使用局部麻醉进行输尿管镜下输尿管结石处理的描述。大多数研究通过灌注2%的普通利多卡因对尿道或膀胱进行局部麻醉。除成功率外，这些研究中疼痛感知是通过主观使用非标准标准来报告的。对于输尿管镜检查，除了尿道和膀胱外，对同侧输尿管和肾盂肾盏系统（PCS）进行局部麻醉以及使用碱化利多卡因以增强效果的情况尚未见报道。利用这些概念上的改变，我们测试了在我们的全腔内局部麻醉（TILTA）技术下进行输尿管镜检查和激光碎石术的安全性和有效性。
168例患者通过向膀胱、同侧输尿管和PCS局部灌注碱化利多卡因进行输尿管镜激光碎石术。在不同时间对自我评估的疼痛感知和生命体征参数变化进行客观评分。记录成功率、失败原因、最大疼痛评分、并发症以及接受重复手术的意愿。
成功率为91.3%，平均持续时间为14.7分钟。38.1%的患者放置了双J支架（DJS）。61.3%的患者术后不需要任何注射用镇痛药，11.3%的患者需要不止一剂。术中生命体征在最初和疼痛高峰时的变化无统计学意义（p>0.05）。静脉穿刺置管和输尿管镜检查之间自我评估的中位疼痛评分有显著差异（p<0.05）。
在TILTA技术下有效进行的输尿管镜检查是安全的，成功率高。可接受的疼痛耐受性和缩短的康复期此外还使得该手术的成功值得承受疼痛。
