title: Randomized prospective evaluation of nephrostomy tube configuration: impact on postoperative pain.
abstract: OBJECTIVE
  Conduct a prospective randomized single-blind comparison of two nephrostomy catheter designs, evaluating specifically intraoperative placement and postoperative comfort.
  
  
  METHODS
  The single-blind, prospective randomized trial was conducted with institutional review board approval. All patients undergoing percutaneous nephrolithotomy who gave informed consent were randomized to placement of either a Boston Scientific Flexima 8.3F pigtail nephrostomy tube #27-180 (PIG) or a Boston Scientific 8.2F nephroureteral stent #410-126 (NUS). Randomization was concealed from the surgeon until time of placement. Subjective intraoperative placement characteristics were rated by the surgeon on a scale of 1 = excellent, 2 = fair, 3 = good and 4 = poor. The patient's postoperative pain intensity was evaluated with a Visual Analog Pain Score (0 = no pain to 10 = worst pain).
  
  
  RESULTS
  Nine patients were randomized to each group. The PIG group was rated significantly better than the NUS group with regards to ease of placement (p = 0.007) and radiopacity of the tube (p = 0.007) by surgeon. Visual analog pain scores on postoperative day one, was significantly lower in the PIG group (mean = 2+/-2) than the NUS group (mean = 5+/-1) (p =0.004). The mean amount of intra-venous morphine equivalent given in the PIG group (mean = 1+/4 Eq morphine) was less on average compared to the NUS group (mean = 6+/13 Eq morphine), but the differences did not reach statistical significance (p = 0.06).
  
  
  CONCLUSIONS
  Following percutaneous nephrolithotomy, use of a small pig-tail nephrostomy tube results in greater ease of placement and less postoperative pain than a nephroureteral catheter.
authors.affiliation: Department of Urologic Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Weiland
authors.forename: Renato N
authors.initials: RN
authors.lastname: Pedro
authors.forename: J Kyle
authors.initials: JK
authors.lastname: Anderson
authors.forename: Sara L
authors.initials: SL
authors.lastname: Best
authors.forename: Courtney
authors.initials: C
authors.lastname: Lee
authors.forename: Kari
authors.initials: K
authors.lastname: Hendlin
authors.forename: Johnstone
authors.initials: J
authors.lastname: Kim
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002404:Catheterization / Q000295:instrumentation*; D004322:Drainage / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid