The effect of nephrostomy tract infiltration of ketamine on postoperative pain and peak expiratory flow rate in patients undergoing tubeless percutaneous nephrolithotomy: a prospective randomized clinical trial

Abstract

Ketamine, as a systemic and local analgesic, has been used to reduce postoperative pain in many studies. The present study was designed to assess the analgesic efficacy of nephrostomy tract infiltration of ketamine in postoperative pain after tubeless percutaneous nephrolithotomy (PCNL). Sixty-six patients with renal stone who were candidates for PCNL were randomized to two groups with 33 patients in each group. In group K, 20 mL saline solution containing 1.5 mg/kg ketamine was infiltrated into the nephrostomy tract and in group C, 20 mL saline solution was infiltrated into the nephrostomy tract at the end of surgery. The postoperative pain scores, sedation scores, time to first rescue analgesia, rescue analgesic requirement, peak expiratory flow rate (PEF), and hemodynamic parameters were compared between two groups. Sixty-six patients with a mean age of 45.29 ± 15 years and an age range of 18-60 years participated in this study. There was no significant difference in the demographic data and duration of surgery between the two groups. The mean VAS scores were significantly lower in the intervention group compared with the control group at the recovery, and 4 and 6 h postoperatively (p = 0.001). The mean time to first rescue analgesia in the postoperative period was significantly lower in the control group (64.5 ± 8.1 min) compared with the intervention group (122 ± 18.4 min). The trend of first opioid administration was significantly lower in the ketamine group p < 0.009. There was no significant differences in PEF between the two groups in the postoperative period (p = 0.622). In conclusion infiltration of ketamine into the nephrostomy tract provides superior analgesic and sedative effects in PCNL surgery without significant changes in PEF.

Should the Erector Spinae Plane Block Be Applied in the Pain Management of Percutaneous Nephrolithotomy?

“…In PNL surgery, Hosseini et al investigated the effectiveness of peritubal ketamine infiltration and Imani et al also investigated the analgesic efficacy of ropivacaine infiltration and its effects on PEFR values. In these studies, it was shown that PEFR values decreased significantly in the early postoperative period after PNL, but pain management with peritubal infiltration did not affect PEFR values positively [ 4 , 19 ].…”

“…Pain related to PCNL may cause nausea and vomiting, and aggressive management with opioids alone can result in respiratory depression [ 4 ]. Tramadol is a weak opioid used for postoperative pain relief without causing the respiratory depression seen with other opioids.…”

Should the Erector Spinae Plane Block Be Applied in the Pain Management of Percutaneous Nephrolithotomy?

“…PEFR value may decrease in the early postoperative period due to pain 19 . In PNL surgery, Hosseini et al 4 investigated the effectiveness of peritubal ketamine infiltration and Imani et al 20 also investigated the analgesic efficacy of ropivacaine infiltration and its effects on PEFR values. In these studies, it was shown that PEFR values decreased significantly in the early postoperative period after PNL, but pain management with peritubal infiltration did not affect PEFR values positively 4,20 .…”

“…Pain related to the PCNL may cause nausea and vomiting, and aggressive management with opioids alone can result in respiratory depression 4 . Tramadol is a weak opioid used for postoperative pain relief without causing the respiratory depression seen with other opioids.…”

The impact of post PCNL tube type on blood loss and postoperative pain

“…There are many ways of reducing postoperative pain. These include local anesthetic infiltration into the tract 9 reducing the renal pelvic pressure during surgery, paravertebral block (T11-L1), using postoperative opioid analgesia, reducing the size of nephrostomy tube or not placing a nephrostomy tube at all. [10][11][12][13] Multiple studies have shown that tubeless PCNL is safe and feasible for select group of patients.…”