Ultrasound guided peritubal infiltration of 0.25% ropivacaine for postoperative pain relief in percutaneous nephrolithotomy.

BACKGROUND Percutaneous nephrolithotomy (PCNL) is a common endourologic procedure with less morbidity than open surgery. However, pain around the nephrostomy tube requires good post operative analgesia. So we hypothesize that infiltration of local anesthetic from the renal capsule to the skin around the nephrostomy tract would relieve the pain in the initial postoperative period. METHODS 60 adult patients of either sex with ASA physical status I to III and undergoing percutaneous nephrolithotomy were randomized for a prospective double-blind controlled study. Patients were divided into control group (n = 30) and ropivacaine group (n = 30). Balanced general anesthesia was given. After completion of surgical procedure, 23 gauge spinal needle was inserted at 6 and 12 o'clock position under ultrasonic guidance up to therenal capsule along the nephrostomy tube. 10 ml of 0.25% ropivacaine or normal saline solution was infiltrated in each tract while withdrawing the needle from renal capsule to the skin. Post-operative pain was assessed using visual analogue scale (VAS) and dynamic visual analogue scale (D-VAS) during deep breathing and coughing on a scale of 0-10 during the initial postoperative 24 hours. Rescue analgesia was given in the form of injection tramadol 1.0 mg/kg intravenously when VAS > 4 and maximum up to 400mg in 24 hours. Time to first rescue analgesic, number of doses of tramadol and total amount of tramadol required in the initial postoperative 24 hours were noted. Patients were observed for any side effect and treated accordingly. RESULTS VAS at rest (VAS) as well as during deep breathing and coughing (DVAS) were significantly lower in ropivacaine group during first 24 hours. Mean time to 1st rescue analgesic in ropivacaine group was longer (10.7 +/- 2.64 hours) as compared to control group (2.05 +/- 1.44 hours) (P = 0.0001). Mean number of doses of tramadol in 24 hours in group-R were less (2.25 +/- 0.51) than group-C (4.4 +/- 0.68) (P = 0.0001). The mean total amount of tramadol in 24 hours in group-R was significantly lower than group-C. Side effects like nausea and vomiting and sedation were minimum and non-significant in both groups. CONCLUSION Local anesthetic infiltration of 0.25% ropivacaine along the nephrostomy tract is efficient in alleviating post-operative pain after percutaneous nephrolithotomy surgery. The number of doses and total consumption of rescue analgesic were also decreased in the initial postoperative 24 hours.