The efficacy of bupivacaine infiltration on the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy: a prospective, randomized, multicenter study

Urology. 2013 Sep;82(3):526-31. doi: 10.1016/j.urology.2013.02.083. Epub 2013 Jul 4.


Objective: To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL).

Methods: This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients.

Results: The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P <.05). The VAS pain scores in patients with tubeless PCNL were significantly lower than those in patients with standard PCNL (P <.05).

Conclusion: The pain after tubeless and standard PCNL may be decreased by bupivacaine infiltration into the nephrostomy tract. The findings of the present study reveal that a tubeless procedure and local analgesic infiltration into the nephrostomy tract after the PCNL is the more comfortable procedure for the patients.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use
  • Anesthesia, Local*
  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / therapeutic use*
  • Bupivacaine / administration & dosage
  • Bupivacaine / therapeutic use*
  • Cyclooxygenase Inhibitors / therapeutic use
  • Diclofenac / therapeutic use
  • Female
  • Humans
  • Male
  • Meperidine / therapeutic use
  • Middle Aged
  • Nephrostomy, Percutaneous / adverse effects*
  • Nephrostomy, Percutaneous / methods
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Time Factors
  • Young Adult


  • Analgesics, Opioid
  • Anesthetics, Local
  • Cyclooxygenase Inhibitors
  • Diclofenac
  • Meperidine
  • Bupivacaine