title: Efficacy of intravesical ropivacaine injection on urinary symptoms following ureteral stenting: a randomized, controlled study.
abstract: OBJECTIVE
  Previous studies suggest that intravesical administration of nonsteroidal anti-inflammatory drugs may reduce the troublesome voiding symptoms and pain related to ureteral stenting. The objective of this study was to investigate the effectiveness of a long-acting local anesthetic, ropivacaine, injected submucosally into the bladder to control ureteral stent-associated symptoms.
  
  
  METHODS
  A randomized, single-blinded, study approved by our Institutional Review Board of adult patients scheduled for ureteroscopic stone surgery and possible stent placement was conducted. Patients were randomized to either the treatment cohort, who received five injections of 2 mL 0.5% ropivacaine around the ureteral orifice or to the control cohort, who received five injections of 2 mL of 0.9% normal saline in identical locations. Pain scale questionnaires were provided to each subject preoperatively and at postoperative hours 2, 4, 8, 24, and 48 as well as on the day of stent removal. Student's t test and Wilcoxon signed rank sum tests were used for Gaussian and nonparametric data, respectively.
  
  
  RESULTS
  Twenty-two patients were randomized evenly into the two cohorts. The ropivacaine group consisted of 11 patients (eight men and three women) with a mean age of 56.2 years (standard deviation [SD] = 12, range 27-69), and the saline group consisted of eleven patients (six men and five women) with a mean age of 47.8 years (SD = 6.6, range 37-58). Intraoperative parameters appeared similar between the two cohorts. Intraoperative and postoperative narcotic usage was not different between the two groups, except at postoperative hour 2 when it favored the ropivacaine cohort (P = 0.05). Trends favoring ropivacaine in flank pain, bladder pain, genitalia pain, and hematuria domains were seen as long as 8 hours and up to the day of stent removal. Trends of less magnitude and duration were seen in the dysuria domain. No differences were seen in the frequency and urgency domains.
  
  
  CONCLUSIONS
  Our preliminary investigation with intravesical injection of ropivacaine before ureteroscopic surgery demonstrated trends toward decreased pain and voiding symptoms in this small-sample study. Inclusion of a larger sample should definitively address the effectiveness of intravesical ropivacaine and its impact on stent-related symptoms.
authors.affiliation: Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Sur
authors.forename: George E
authors.initials: GE
authors.lastname: Haleblian
authors.forename: David A
authors.initials: DA
authors.lastname: Cantor
authors.forename: W Patrick
authors.initials: WP
authors.lastname: Springhart
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
mesh_terms: D000283:Administration, Intravesical; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D000077212:Ropivacaine; D015607:Stents / Q000009:adverse effects*; D018666:Ureteroscopy / Q000009:adverse effects*; D014555:Urination Disorders / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine