The efficacy of 0.25% bupivacaine infiltration in tubeless percutaneous nephrolithotomy in singular stone of the pelvis: A randomized clinical trial

Abstract

Background: Postoperative pain is a significant concern following percutaneous nephrolithotomy (PCNL). While tubeless PCNL has reduced discomfort, effective and simple analgesic techniques are still needed.

Materials and Methods: A double?blind, randomized controlled trial was conducted at two tertiary hospitals with 120 adult patients having solitary renal pelvic stones <3 cm. Patients were randomized into two groups: the intervention group received 20 mL of 0.25% bupivacaine infiltrated into the tract at surgery end, and the control group received no infiltration. Postoperative pain was assessed using the visual analog scale (VAS) at 6, 12, and 24 h. Both patients and outcome assessors were blinded. Data from 57 intervention and 56 control patients were analyzed.

Results: Baseline demographic, anatomical, and perioperative characteristics were well?matched between the two groups (all P > 0.05). Repeated?measures analysis of variance revealed a significant main effect for both time (P < 0.001) and treatment group (P = 0.006). The bupivacaine group consistently reported significantly lower mean VAS pain scores at 6 h (4.33 ± 0.97 vs. 4.85 ± 1.05, P = 0.008), 12 h (2.68 ± 0.81 vs. 3.16 ± 0.95, P = 0.005), and 24 h (1.53 ± 0.68 vs. 1.84 ± 0.71, P = 0.018) than the control group postoperatively.

Conclusion: Infiltration of the nephrostomy tract with 0.25% bupivacaine is a simple and effective method for significantly reducing postoperative pain at 6, 12, and 24 h after tubeless PCNL. This technique provides a sustained analgesic benefit and should be considered for routine implementation to enhance patient recovery.