Intermittent peri‐tubal instillation of dexamethasone and ropivacaine on postoperative analgesia after percutaneous nephrolithotomy: A prospective randomized controlled trial

Intermittent peri‐tubal instillation of dexamethasone and ropivacaine on postoperative analgesia after percutaneous nephrolithotomy: A prospective randomized controlled trial

Objectives Percutaneous nephrolithotomy and placement of nephrostomy tube are performed for renal stones >2 cm in diameter. Attempts have been made to infiltrate local anesthetics with or without adjuvants into the surgical site to reduce pain. We hypothesized that there would be a significant pr...

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Bibliographic Details
Published in:International journal of urology Vol. 29; no. 8; pp. 876 - 883
Main Authors: Ahuja, Varnika, Luthra, Ankur, Chauhan, Rajeev, Meena, Shyam C, Parmar, Kalpesh
Format: Journal Article
Language:English
Published: Australia Wiley Subscription Services, Inc 01-08-2022
Subjects:
Adjuvants
Analgesia
Analgesics
Anesthetics
Clinical trials
Dexamethasone
Fentanyl
Local anesthetics
Nephrolithiasis
nephrostomy
Pain perception
Patients
percutaneous nephrolithotomy
Ropivacaine
urolithiasis
Urological surgery
wound infiltration catheter
dexamethasone
ropivacaine
urolithiasis
nephrostomy
wound infiltration catheter
percutaneous nephrolithotomy
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Summary:Objectives Percutaneous nephrolithotomy and placement of nephrostomy tube are performed for renal stones >2 cm in diameter. Attempts have been made to infiltrate local anesthetics with or without adjuvants into the surgical site to reduce pain. We hypothesized that there would be a significant prolongation of the analgesic effect of local anesthetic instillation along the nephrostomy tube due to the adjuvant dexamethasone. Methods After ethical approval and Clinical Trials Registry ‐ India registration (CTRI/2020/03/024332), 64 American Society of Anesthesiologists classification 1 and 2 adult patients were enrolled in this randomized double‐blinded prospective study divided into Group R—received 20 mL 0.2% Ropivacaine and Group R + D—received 20 mL 0.2% Ropivacaine with dexamethasone 8 mg, injected through a multi‐lumen wound infiltration catheter. Results The demographic profile of patients was similar in both groups. The mean duration of analgesia was longer in Group R + D (21.3 ± 2.1 hrs) versus Group R (10 ± 1.9 hrs, P = 0.001). The mean numeric rating scale scores of Group R + D were significantly lower at all time intervals (P = 0.001). Also, the cumulative dose of ropivacaine and the total use of fentanyl postoperatively in Group R was much higher (70 ± 10.4 vs 56 ± 8.9 μg, P = 0.02). The C‐reactive protein levels were significantly lower in Group R + D (13.8 ± 1.5 vs 23.1 ± 1.2 mg/L, P = 0.001 and 16.5 ± 1.3 vs 28.5 ± 1.7 mg/L, P = 0.001, at 24 and 48 hrs, respectively). Conclusion We conclude that dexamethasone can be used as a suitable adjuvant to intermittent local anesthetic infiltration after percutaneous nephrolithotomy with a nephrostomy tube for the prolongation of analgesia.
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ISSN:0919-8172
1442-2042
DOI:10.1111/iju.14929