title: A randomized control trial evaluating efficacy of nephrostomy tract infiltration with bupivacaine after tubeless percutaneous nephrolithotomy.
abstract: OBJECTIVE
  We conducted a randomized controlled trial to assess the efficacy of nephrostomy tract infiltration with bupivacaine in tubeless percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  All adult patients undergoing unilateral tubeless PCNL from July 1, 2007 to October 31, 2007 were included in the study. Patients were randomized to receive infiltration of bupivacaine in the nephrostomy tract at the end of the procedure or not to receive bupivacaine. To show a 10% difference in postoperative pain, a sample size of 30 persons per group would be needed. Postoperatively, the pain score were obtained at 4 and 24 hours by a nurse who was blinded to the protocol. The perioperative outcome of these patients (study group) was compared with those undergoing tubeless PCNL without nephrostomy tract infiltration of bupivacaine (control group).
  
  
  RESULTS
  Patient demographics and intraoperative parameters in both groups were comparable. Supracostal access was needed in 65.7% and 72.7% patients in the study and control group, respectively. The nephrostomy tract were infiltrated with bupivacaine in 31 patients. The visual analogue pain score at 4 hours and 24 hours for the study group was 2.66 ± 1.07 & 2.23 ± 0.50 respectively, while in control group was 5.15 ± 1.52 and 3.22 ± 1.11, respectively (P=0.000). There was a trend toward lesser analgesia requirement in the study group (94.8 vs 124.2 mg of diclofenac sodium). There was no difference in the duration of postoperative catheterization, hospital stay, stone-free rates, and complication between both groups.
  
  
  CONCLUSIONS
  Nephrostomy tract infiltration of bupivacaine in tubeless PCNL is associated with less postoperative pain and analgesia requirement.
authors.affiliation: Department of Urology, S. L. Raheja (Fortis) Hospital, Mahim (West), Mumbai, India. drhemendrashah@yahoo.co.in
authors.forename: Hemendra N
authors.initials: HN
authors.lastname: Shah
authors.forename: Rashmi H
authors.initials: RH
authors.lastname: Shah
authors.forename: Hiren S
authors.initials: HS
authors.lastname: Sodha
authors.forename: Amit A
authors.initials: AA
authors.lastname: Khandkar
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Gokhale
mesh_terms: D002045:Bupivacaine / Q000494:pharmacology*; D003710:Demography; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D002045:Bupivacaine