A bupivacaine injection along the tract of the nephrostomy site at the time of percutaneous nephrolithotomy (PCNL) reduces postoperative pain as well as the need for narcotic medication, according to study results presented at the 2016 Annual Meeting of the American Urological Association (AUA).
Lead author James Mason, MD, University of Florida, Gainesville, Florida, speaking here on May 6, said he recommends the use of bupivacaine in all patients after PCNL.
Dr. Mason and colleagues compared pain control in 22 patients who received a bupivacaine injection and 22 control patients not receiving a bupivacaine injection.
In the treated cohort, 30 mL of 0.25% bupivacaine with epinephrine was injected into 6 locations around the circumference of the nephrostomy tract at the conclusion of the procedure.
The primary endpoint was total post-operative narcotic usage measured in morphine equivalents. Secondary endpoints included postoperative pain scores and total length of admission.
Patient-reported pain levels in the bupivacaine group measured at 1, 6, and 12 hours post-operatively were significantly improved compared with the non-bupivacaine group (P ˂ .05). Total narcotic usage for the first 8 hours postoperatively was also significantly decreased in the bupivacaine group (P ˂ .05).
Total cumulative narcotic usage in the bupivacaine and non-bupivacaine groups was 120.1 mg and 172.6 mg, respectively. There was no statistically significant difference in cumulative narcotic use at 24 hours.
The average length of stay in hospital for patients in the bupivacaine arm decreased by 20% (2.05 vs 2.55 days); however, this finding was not significant (P = .24).
There were no reported side effects or complications from bupivacaine injection.
Pain was assessed using the Defense and Veterans Pain Rating Scale (DVPRS), and pain medication was administered by nursing staff per protocol, according to reported pain levels.
The bupivacaine and non-bupivacaine groups were similar with respect to demographic and clinical characteristics.
Dr. Mason added that longer-acting agents such as liposomal bupivacaine or lidocaine may have similar benefits, and should be investigated.
[Presentation title: Improved Pain Control with Local Anaesthetic after Percutaneous Nephrolithotomy: A Resident-Driven Quality Improvement Study. Abstract number MP08-07]