Post-Operative Pain Score Comparison of Bupivacaine Vs Placebo in Patients   Undergoing Percutaneous Nephrolithotomy

Abstract

Objective: To compare post-operative pain of Bupivacaine vs placebo in patients undergoing percutaneous nephrolithotomy. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi Pakistan, from Aug 21 to Aug 22. Methodology: Eighty-eight patients undergoing percutaneous nephrolithotomy who fulfilled the inclusion criteria were included in study and randomized in two equal groups (44 patients each) by lottery method, Group-A received 20ml/50mg of 0.25% Bupivacaine and Group-B received 20ml normal saline around nephrostomy tube. Post-operatively, the visual analogue scale used to measure pain score at 6, 12 and 24 hours by an independent observer, blinded to randomization. After 24 hours mean of VAS calculated and noted. Results: Mean age of patient in Group-A was 39.40±8.42 years and in Group-B 38.00±8.67 years. There were 65 male (73.86%) and 23 female (26.13%) patients. Mean stone size was 3.00±0.68 cm and 3.006±0.63 cm in Group-A and B respectively. Median pain at 6, 12 and 24 hours was low in Group-A in comparison to Group-B with p-value <0.001. Similarly, overall pain score in 24 hours was also low in Group-A in comparison to Group-B with median (IQR) score being 4(4.33-3.67) vs 6.33(7.24-4), p<0.001. Demand of first post-operative analgesia was significantly prolonged in Group-A (256.68±23.70 minutes) than Group-B (168.72±30.86 minutes, p-value<0.001). Conclusion: The peritubal Bupivacaine infiltration is highly effective in reducing postoperative pain for patients undergoing PCNL as compared to placebo.

Keywords

• Bupivacaine, Local anesthesia, Postoperative pain, Percutaneous nephrolithotomy, Visual analogue scale