Çocuklarda Perkütan Nefrolitotomi Sırasında Uygulanan Lokal Anestezik İnfiltrasyonunun Ameliyat Sonrası Analjezi Üzerine Etkisi

Abstract

We analyzed 40 pediatric patients and 42 renal units who underwent percutaneous nephrolithotomy (PNL) for stone disease between February 2015 and February 2017, in order to prevent postoperative pain and discomfort due to surgery and diversion and to assess the efficacy of preemptive local anesthetics. Patients who received 2 mg/kg of prilocain (0.2%) and 2 mg/kg of bupivacain (0.5%) injection throught the access line before renal access constituted the LA group where patients received no medication constituted the control group. All patients have received the same anesthesia protocol and all of them also recieved 15 mg/kg of paracetamol infusion in every 6 hours postoperatively. Pediatric PNL was performed through 24F access sheath and 14 F nephrostomy chatheter was placed at the end of the procedure to all patients. Patients’ pain scores were evaluated at postoperative 15 minutes, 30 minutes, 1 hour, 6 hours and 24 hours. For pain scoring FLACC Scale (Face, Legs, Activity, Cry, Consolability) was assessed in every patient where FPS (FACES Pain Score-Revised) scale was just used in patients 8 years and older. Patients with pain scores 4 and up recieved additional meperidine 1 mg/kg i.m. as rescue analgesic. Pain scores over 7 were categorized as severe pain. Two groups were compared regarding their demographic data, stone size, stone number, operation lenght, hospitalization lenght, pain scores, presence of severe pain, analgesic manuplation and repetitive doses, drug related side effects, complications and analgesic satisfaction. Groups were founded to be similar according to demographic data, stone characteristics and operation related variables. Pain after PNL founded to be decreasing in time but the decrease rate in LA group was distinctive. Between LA and control groups there was no significant difference in pain scores (FLACC and FPS) except 24th hour, where the LA group found to be favorable (p=0.023 for FLACC, p=0.024 for FPS). Also severe pain presence was insignificant between groups (p=0,726). The rescue analgesic need was significantly less in LA group (p=0.040). Although the need for rescue analgesic was typically seen in first 15 minutes, there was no diffrence regarding analgesic administration in postoperative 15 minutes (p=0.061). Patients in control group received total number of 23 doses of rescue analgesic as LA group received 12 doses causing a marked difference (p=0.018). According to need for repetitive analgesic dose, the LA group was founded to be more advantageous (p=0.017), as there were no child needing 2nd dose of rescue analgesic in LA group. Two groups were founded to be similar regarding drug related side effects. The postoperative analgesic satisfaction of patients’ at 24th hour was favourable in LA group (p=0.002). In pediatric PNL preemptive use of LA infiltration reduces postoperative pain, the need for analgesics, the number analgesics used and also improves patients’ comfort and analgesic satisfaction.