title: Analgesic Efficacy of Nephrostomy Tract inFiltration of Bupivacaine and Ketamine after Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Trial.
abstract: BACKGROUND
  Recently, the use of ketamine as a systemic and local analgesic drug in reducing post-operative pain is studied more frequently.
  
  
  OBJECTIVE
  The aim of the present study was to assess the analgesic efficacy of IV ketamine injection inaddition to nephrostomy tract infiltration of ketamine-bupivacaine on postoperative pain relief after tubeless percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  Patients (n = 100), with renal stone who were candidates for PCNL were randomized to five groups with 20 cases in each: Group C, 10 mL of saline solution was infiltrated into the nephrostomy tract; Group B, 10 mL of 0.25% bupivacaine was infiltrated into the nephrostomy tract; Group BK1, 10 mL of 0.25% bupivacaine plus 0.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group BK2, 10 mL of 0.25% bupivacaine plus 1.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group K, 10 mL of saline solution containing 0.5 mg/kg ketamine was intravenously administered. Post-operative pain scores were compared between groups as the primary objective. Comparison of Sedation Scores, rescue analgesic consumption, time to the first rescue analgesics administration, hemodynamic and SpO2 values were regarded as the secondary objective.
  
  
  RESULTS
  Mean VAS scores in the first 30 min and total analgesic consumption in the first 24 h of post-operative period were significantly lower in groups BK1 and BK2 in comparison with the other groups (P < 0.05). Also, time to first rescue analgesics administration was longer in the same groups (P < 0.05).
  
  
  CONCLUSIONS
  Infiltration of ketamine plus bupivacaine provides superior analgesic effects in PCNL surgery compared with other methods.
authors.affiliation: Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Shariat Moharari
authors.affiliation: Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Valizade
authors.affiliation: Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.affiliation: Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farhad
authors.initials: F
authors.lastname: Etezadi
authors.affiliation: Associate professor of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Hosseini
authors.affiliation: Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Patricia
authors.initials: P
authors.lastname: Khashayar
authors.affiliation: Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Khajavi
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mojtahedzadeh
keywords: Percutaneous nephrolithotomy; bupivacaine infiltration; ketamine infiltration; postoperative analgesia; renal stone