Mohammad Ali1, Md. Siddiqur Rahman2, MA Monaf3, Rina Akhter4
1. Associate professor (CC), Anaesthesia & ICU, North East Medical College, Sylhet, Bangladesh
2. Associate professor (CC), Urology, North East Medical College, Sylhet, Bangladesh
3. Associate professor, Urology, North East Medical College, Sylhet, Bangladesh
4. Junior Consultant, Gynae & Obs, Gowainghat UHC, Sylhet, Bangladesh
Abstract
Percutaneous nephrolithotomy (PCNL) is a common urological procedure done nowadays in patients with renal stones. Although it is less painful than open surgery, good postoperative analgesia is required to alleviate pain around nephrostomy tube. This randomized case-control study was conducted on 60 patients of either sex having age range 25-60 years of ASA (American Society of Anaesthologists) grade I & II at 2 different private Hospitals of Sylhet during the period of November 2010 to June 2014. Study population was randomly divided in two equal groups of 30 patients each. Patients of study group (group-S) were injected with inj. Bupivacain 0.25% along the nephrostomy tube and control group (Group C) patients were infiltrated with normal saline in the same way. Total procedure was done under fluoroscopic guidance. Postoperative pain score was assessed by visual analog scores (VAS), where score 0 means no pain & score 10 means very severe pain. When the score was 4, rescue analgesia was given in the form of tramadol 1 mg/kg i.m. up to maximum 400 mg in 24 hours. Time to first demand analgesia and total dose of tramadol in first 24 hours was noted. Pain scores at rest was 4 in the immediate post operative period and rescue analgesic requirements for first 24 hours were significantly less in the study group than those of the control group (P<0.05). The first request for demand analgesia was around 9 hours in group S, while in group C it was around 2.57 hours (P < 0.05). Total requirement of tramadol in group S was 117.4 mg and in C group it was 268.8 mg (P<0.05). Peritubal local infiltration of 0.25% bupivacaine is effective in alleviating postoperative pain after PCNL.
Keywords: Peritubal block, Percutaneous nephrolithotomy, Postoperative analgesia.