Document Detail


Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size.
MedLine Citation:
PMID:  12965069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for managing large renal calculi. Investigations have recently focused on reducing the morbidity of the procedure and improving postoperative patient comfort by using smaller endoscopic instruments. We sought to evaluate the effect of a smaller percutaneous drainage catheter on postoperative pain. PATIENTS AND METHODS: Thirty consecutive patients were randomized to receive either a 10F pigtail catheter or a 22F Councill-tip catheter for their percutaneous drainage after PCNL. The demographics were similar in the two groups, as was the rate of supracostal access (47% v 43%, respectively). Self-assessed analog pain scores were collected at 6 hours postoperatively as well as on the morning of the first and second postoperative days (POD). Total narcotic usage was tabulated using morphine equivalents. Complications, including the change from baseline hematocrit, were reviewed. RESULTS: There was no significant difference in the change in hematocrit (6.8 v 6.2 percentage points, respectively). Those patients with the smaller nephrostomy tube noted significantly lower pain scores at 6 hours (3.75 v 5.3; P=0.03). Although the pain scores were lower on POD 1 and 2 for the 10F catheter group, the difference was not statistically different (1.9 v 2.9 and 1.25 v 1.9, respectively; both P>0.05). The patients having the 10F catheter required fewer narcotics: 78 mg v 91 mg, although the difference was not statistically significant. CONCLUSION: The use of a small drainage catheter after PCNL is associated with lower pain scores in the immediate postoperative period, yet no statistically significant benefit to the patient with regard to comfort is demonstrated beyond 6 hours. In addition, there is a trend toward reduced narcotic requirements. Finally, there is no apparent increase in patient morbidity from the use of the smaller nephrostomy tubes.
Authors:
Paul K Pietrow; Brian K Auge; Costas D Lallas; Robert W Santa-Cruz; Glenn E Newman; David M Albala; Glenn M Preminger
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  17     ISSN:  0892-7790     ISO Abbreviation:  J. Endourol.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-09-10     Completed Date:  2004-01-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  411-4     Citation Subset:  IM    
Affiliation:
Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. pktrow@aol.com
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MeSH Terms
Descriptor/Qualifier:
Catheterization / instrumentation*
Female
Hematocrit
Humans
Male
Middle Aged
Nephrostomy, Percutaneous / adverse effects*,  instrumentation*
Pain Measurement
Pain, Postoperative / etiology*
Treatment Outcome
Comments/Corrections
Comment In:
J Urol. 2005 Apr;173(4):1199-200   [PMID:  15758743 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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