Peritubal bupivacaine infiltration for postoperative pain reduction after percutaneous nephrolithotomy
Keywords:
percutaneous nephrolithotomy, peritubal infiltration, bupivacaine, postoperative painAbstract
OBJECTIVE
To compare the effect of peritubal bupivacaine infiltration to conventional pain management for postoperative pain reduction after percutaneous nephrolithotomy.
METHODS
Two independent reviewers systematically searched through electronic databases including the Cochrane Library, PubMed, Trip Database and Scopus using the term “percutaneous nephrolithotomy” or “PCNL” or “PNL” together with “bupivacaine”. We also sought for additional studies using a hand searching to identify all relevant randomized controlled trials (RCTs). We used the Cochrane Collaboration Tool for assessing the risk of bias. Criteria for inclusion in our meta-analysis included participants with percutaneous nephrolithotomy who were assigned randomly to peritubal bupivacaine infiltration or no local anesthetic infiltration and the outcomes were postoperative pain and time to first demand analgesia.
RESULTS
Eight RCTs were included in the meta-analysis with 652 patients undergoing percutaneous nephrolithotomy; peritubal bupivacaine infiltration (N=327) and no local anesthetic infiltration (N=325). The mean visual analog scale (VAS) at 6 hours postoperative care in peritubal bupivacaine infiltration was significantly lower than that of no local anesthetic infiltration (mean difference (MD), -1.36; 95% confidence interval (CI), -1.54 to -1.19). Five RCTs were included in the meta-analysis for time to first demand analgesia evaluation with 415 patients; peritubal bupivacaine infiltration (N=209) and no anesthetic infiltration (N=206). The mean time to first demand analgesia was longer than no local anesthetic infiltration group (MD, 170.4 minutes; 95% confidence interval,161.3 to 179.5 minutes).
CONCLUSION
This meta-analysis found that the peritubal bupivacaine infiltration was significant in alleviating immediate postoperative pain and delaying the time to first demand for analgesia after percutaneous nephrolithotomy.
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