RESUMEN
BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is a safe and effective endourologic procedure in patients with renal calculi. It is less morbid than open surgery. However, the patient complains of pain around the nephrostomy tube and demands for good postoperative analgesia. Skin infiltration with bupivacaine around the nephrostomy tube is not effective, so we hypothesize that peritubal infiltration of bupivacaine from renal capsule to the skin along the nephrostomy tract may alleviate postoperative pain. PATIENTS AND METHODS: A randomized controlled study was designed in 40 American Society of Anesthesiologists (ASA) grade I patients to assess the impact of peritubal bupivacaine infiltration with 23-gauge spinal needle along the nephrostomy tract after PCNL under fluoroscopic guidance. Patients were randomized to receive 20 mL of 0.25% bupivacaine in block group (n = 20) or no infiltration in control group (n = 20) at the conclusion of the procedure. Postoperative pain score and analgesic requirement for the first 24 hours were assessed by visual and dynamic visual analog scales second hourly. Rescue analgesia with injection tramadol Hcl 50-100 mg was given intravenously to a maximum total dose of 400 mg when pain score exceeded 4. RESULTS: Pain scores and analgesic requirement for the first 24 hours postoperatively were significantly lesser in the block group than in the control group of patients at all points of time and were statistically significant (p < 0.005). CONCLUSION: In this study a significant difference in the pain scores and analgesic requirement was noted in the two groups of patients. Peritubal infiltration of 0.25% bupivacaine solution is efficient in alleviating postoperative pain after PCNL.
Asunto(s)
Anestésicos Locales/uso terapéutico , Nefrostomía Percutánea/efectos adversos , Nefrostomía Percutánea/instrumentación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Adulto , Demografía , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Buccal mucosal graft (BMG) substitution urethroplasty has become popular in the management of intractable anterior urethral strictures with good results. Excellent long-term results have been reported by both dorsal and ventral onlay techniques. Asopa reported a successful technique for dorsal placement of BMG in long anterior urethral strictures through a ventral sagittal approach. OBJECTIVE: To evaluate prospectively the results and advantages of dorsal BMG urethroplasty for recurrent anterior urethral strictures by a ventral sagittal urethrotomy approach (Asopa technique). DESIGN, SETTING, AND PARTICIPANTS: From December 2002 to December 2007, a total of 58 men underwent dorsal BMG urethroplasty by a ventral sagittal urethrotomy approach for recurrent urethral strictures. Forty-five of these patients with a follow-up period of 12-60 mo were prospectively evaluated, and the results were analysed. INTERVENTION: The urethra was split twice at the site of the stricture both ventrally and dorsally without mobilising it from its bed, and the buccal mucosal graft was secured in the dorsal urethral defect. The urethra was then retubularised in one stage. RESULTS AND LIMITATIONS: The overall results were good (87%), with a mean follow-up period of 42 mo. Seven patients developed minor wound infection, and five patients developed fistulae. There were six recurrences (6:45, 13%) during the follow-up period of 12-60 mo. Two patients with a panurethral stricture and four with bulbar or penobulbar strictures developed recurrences and were managed by optical urethrotomy and self-dilatation. The medium-term results were as good as those reported with the dorsal urethrotomy approach. Long-term results from this and other series are awaited. More randomised trials and meta-analyses are needed to establish this technique as a procedure of choice in future. CONCLUSIONS: The ventral sagittal urethrotomy approach is easier to perform than the dorsal urethrotomy approach, has good results, and is especially useful in long anterior urethral strictures.