Randomized prospective evaluation of nephrostomy tube configuration: impact on postoperative pain

Introduction: Mini Percutaneous Nephrolithotomy (mPCNL) is a safe and efficient method for management of nephrolithiasis. Post procedure nephrostomy tube drainage is considered as the standard practice. In recent years, tubeless mPCNL with the use of double J (DJ) stent alone has replaced the placement of the nephrostomy tube. Aims: This study intends to evaluate the safety and efficacy of tubeless Mini Percutaneous Nephrolithotomy. Methods: A total of 80 patients with Nephrolithiasis, admitted to Urology Unit of Nepalgunj Medical College, between September 2018 and September 2019 were enrolled in the study and divided into two groups: Tubeless group where tube was omitted and Standard Group where it was placed. The two groups were compared with respect to hemoglobin drop and blood transfusion requirement, hospital stay and analgesic requirement in the post-operative period. Results: Mean age of the patients was 34.30 ± 13.19 years. Mean stone size was 19.03 mm. The mean change in hemoglobin after standard mPCNL was 1.68 gm/dl and that in the tubeless group was 1.11 (p=0.018). The tubeless group had a significantly (p=0.001) shorter hospital stay (3.05 ± 1.23 days) compared to standard group (3.85 ± 0.86). The postoperative pain as assessed by visual analogue scale, was more in the standard group necessitating additional analgesia. It was significantly higher in the standard group at 12, 24, 48 hours, as compared to the tubeless group. Conclusion: Placement of nephrostomy tube can be omitted as a routine practice as Tubeless mini PCNL has an added advantage of significantly reduced postoperative pain, less analgesic requirement, shorter hospital stay, less postoperative blood loss.

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The Results of the Paper by Westhoff et al. “Prospective Evaluation of Antibiotic Management in Ureteral Stent and Nephrostomy Interventions” Should Encourage Proper Use of Antimicrobial Prophylaxis in Patients Undergoing Nephrostomy Tube Replacement

Urologia Internationalis ◽

10.1159/000520804 ◽

2021 ◽

pp. 1-2

Author(s):

Luca Ongaro ◽

Michele Rizzo ◽

Carlo Trombetta ◽

Giovanni Liguori

Keyword(s):

Antimicrobial Prophylaxis ◽

Ureteral Stent ◽

Nephrostomy Tube ◽

Prospective Evaluation ◽

Antibiotic Management

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The plug method in inguinal hernia: Prospective evaluation of postoperative pain and disability

Hernia ◽

10.1007/bf01234756 ◽

1997 ◽

Vol 1 (4) ◽

pp. 185-189 ◽

Cited By ~ 18

Author(s):

E. P. P�lissier ◽

D. Blum

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Prospective Evaluation

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Prospective evaluation of pain and analgesic use following major elective intracranial surgery

Journal of Neurosurgery ◽

10.3171/jns.2007.106.2.210 ◽

2007 ◽

Vol 106 (2) ◽

pp. 210-216 ◽

Cited By ~ 95

Author(s):

Allan Gottschalk ◽

Lauren C. Berkow ◽

Robert D. Stevens ◽

Marek Mirski ◽

Richard E. Thompson ◽

...

Keyword(s):

Postoperative Pain ◽

Prospective Study ◽

Severe Pain ◽

Prospective Evaluation ◽

Intracranial Surgery ◽

Pain Scores ◽

Opioid Administration ◽

Pain At Rest ◽

A Prospective Study ◽

Analgesic Use

Object Opioid administration after major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect the postoperative neurological examination. The authors conducted a prospective study to evaluate the incidence, severity, and treatment of postoperative pain in patients who underwent major intracranial surgery. Methods One hundred eighty-seven patients (77 men and 110 women, mean age 52 ± 15 years, mean weight 78.1 ± 19.9 kg) underwent either supratentorial (129 patients) or infratentorial (58 patients) procedures. Sixty-nine percent of the patients reported experiencing moderate to severe pain (≥ 4 on a 0–10 scale) during the 1st postoperative day. Pain scores greater than or equal to 4 persisted in 48% on the 2nd postoperative day. Approximately 80% of patients were treated with acetaminophen on the 1st postoperative day, whereas opioids (primarily intravenous fentanyl) were administered to 58%. Compared with patients who underwent supratentorial procedures, those who underwent infratentorial procedures reported more severe pain at rest (mean score 4.9 ± 2.2 compared with 3.8 ± 2.6; p = 0.015) and with movement (mean score 6.3 ± 2.6 compared with 4.5 ± 2.7; p < 0.001) on the 1st postoperative day. On both the 1st and 2nd postoperative days, patients who underwent infratentorial procedures received greater quantities of opioid (p ≤ 0.019) and nonopioid (p ≤ 0.013) analgesics than those who underwent supratentorial procedures. Patients’ dissatisfaction with analgesic therapy was significantly associated with elevated pain levels on the first 2 postoperative days (p < 0.001). Conclusions In contrast to prevailing assumptions, the study findings reveal that most patients undergoing elective major intracranial surgery will experience moderate to severe pain for the first 2 days after surgery and that this pain is often inadequately treated.

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The Polysoft® patch: prospective evaluation of feasibility, postoperative pain and recovery

Hernia ◽

10.1007/s10029-007-0203-x ◽

2007 ◽

Vol 11 (3) ◽

pp. 229-234 ◽

Cited By ~ 20

Author(s):

E. P. Pélissier ◽

O. Monek ◽

D. Blum ◽

Ph. Ngo

Keyword(s):

Postoperative Pain ◽

Prospective Evaluation

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A Randomized Prospective Evaluation of 3 Techniques of Postoperative Pain Management After Posterior Spinal Instrumentation and Fusion

Spine ◽

10.1097/brs.0b013e31829cab0b ◽

2013 ◽

Vol 38 (19) ◽

pp. 1626-1631 ◽

Cited By ~ 28

Author(s):

Joshua W. B. Klatt ◽

Jennie Mickelson ◽

Man Hung ◽

Simon Durcan ◽

Chris Miller ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Spinal Instrumentation ◽

Postoperative Pain Management ◽

Prospective Evaluation

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

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.3.1558 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Salman Jamil ◽

M Hammad Ather

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Pain Score ◽

Randomized Study ◽

University Hospital ◽

P Value ◽

Nephrostomy Tube ◽

Tube Type ◽

The Impact ◽

Hemoglobin Drop

Objective: To evaluate the impact of nephrostomy tube type on postoperative pain and blood loss following percutaneous nephrolithotomy (PCNL). Methods: This is a prospective non-randomized study performed at Aga Khan University Hospital from July 2017 to June 2018. In this study we prospectively studied adult patients (16 to 65 years) who underwent unilateral PCNL. Patients who had nephrostomy with balloon (12Fr Foley’s catheter) were compared with patients who had nephrostomy without balloon (12Fr Nelaton™ catheter). STONE Nephrolithometry score was used to assess the stone complexity. Mean pain score at six and 24 hours and mean hemoglobin drop at 24 hours was compared between two groups using independent sample t-test, p-value of <0.05 was considered significant. Results: Over one year, 198 PCNL were performed out of which 119 were included for analysis. Sixty-six had nephrostomy tube with balloon and 53 had nephrostomy tube without balloon. Mean STONE score (9.66±1.4 vs. 9.64±1.24) and operative time (72.84±28.34 vs. 86.05±32.1 minutes) was comparable. Mean postoperative pain score at 6 hours and 24 hours postoperative was significantly lower in balloon group as compared to without balloon group. Mean Hemoglobin drop was similar in both groups (p=0.60). Conclusion: The use of nephrostomy tube with balloon after PCNL as this is associated with less pain and comparable hemoglobin drop as compare to nephrostomy tube without balloon. doi: https://doi.org/10.12669/pjms.36.3.1558 How to cite this:Jamil S, Ather MH. The impact of post PCNL tube type on blood loss and postoperative pain. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1558 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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