Management of postoperative pain following percutaneous nephrolithotripsy (PCNL) is a significant goal. We sought to identify risk factors and clinical correlates of postoperative pain in order to improve perioperative management and patient satisfaction.
Materials and methods:
A single-center, retrospective analysis, from a prospectively maintained database, of all consecutive patients who underwent PCNL for renal calculi between January 2011 and August 2018. Postoperative pain was assessed using the visual analog scale (VAS) and analgesic use. We considered VAS score above 4 as meaningful. Pain management was standardized according to patirnt reported VAS scores. Multivariable logistic regression was performed to identify risk factors and clinical correlates.
Results:
A total of 496 patients were analyzed. Younger age was associated with VAS above 4 on the operative day and the first postoperative following PCNL (p = 0.003 and p < 0.001, respectively). Female gender was associated with VAS above 4 in the first 2 days following the operation (p < 0.001).
Conclusions:
Younger age and female gender would most likely benefit from pre-emptive improved pain management protocols following PCNL.
HaghighiRZeraatiHGhorban ZadeM.Ultra-mini-percutaneous nephrolithotomy (PCNL) versus standard PCNL: a randomised clinical trial. Arab J Urol2017; 15(4): 294–298.
2.
DesaiMRKukrejaRADesaiMM, et al. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol2004; 172(2): 565–567.
3.
PietrowPKAugeBKLallasCD, et al. Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol2003; 17(6): 411–414.
4.
XunYWangQHuH, et al. Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis. BMC Urol2017; 17(1): 102.
5.
Institute of Medicine (US). Committee on advancing pain research, care, and education. Relieving Pain in America: a blueprint for transforming prevention, care, education, and Research. Washington, DC: National Academies Press (US), 2011.
6.
KehletHHolteK.Effect of postoperative analgesia on surgical outcome. Br J Anaesth2001; 87(1): 62–72.
7.
SinghIYadavOKGuptaS.Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: a prospective randomized clinical trial. Urol Ann2019; 11(4): 363–368.
DelgadoDALambertBSBoutrisN, et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev2018; 2(3): e088.
10.
BodianCAFreedmanGHossainS, et al. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology2001; 95(6): 1356–1361.
11.
NevoAHollandRSchreterE, et al. How reliable is the intraoperative assessment of residual fragments during percutaneous nephrolithotomy? A prospective study. J Endourol2018; 32(6): 471–475.
12.
SerlinRCMendozaTRNakamuraY, et al. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain1995; 61(2): 277–284.
13.
PalosGRMendozaTRMobleyGM, et al. Asking the community about cutpoints used to describe mild, moderate, and severe pain. J Pain2006; 7(1): 49–56.
14.
HartrickCTKovanJPShapiroS.The numeric rating scale for clinical pain measurement: a ratio measure?Pain Pract2003; 3(4): 310–316.
15.
LiuQRJiMHDaiYC, et al. Predictors of acute postsurgical pain following gastrointestinal surgery: A Prospective Cohort Study. Pain Res Manag2021; 2021: 6668152.
16.
BhatSLalJPaulF.A randomized controlled study comparing the standard, tubeless, and totally tubeless percutaneous nephrolithotomy procedures for renal stones from a tertiary care hospital. Indian J Urol2017; 33(4): 310–314.
17.
EdwardsRRFillingimRB.Effects of age on temporal summation and habituation of thermal pain: clinical relevance in healthy older and younger adults. J Pain2001; 2(6): 307–317.
18.
EdwardsRRFillingimRBNessTJ.Age-related differences in endogenous pain modulation: a comparison of diffuse noxious inhibitory controls in healthy older and younger adults. Pain2003; 101(1-2): 155–165.
19.
TighePJRileyJL3rdFillingimRB.Sex differences in the incidence of severe pain events following surgery: a review of 333,000 pain scores. Pain Med2014; 15(8): 1390–1404.
20.
UchiyamaKKawaiMTaniM, et al. Gender differences in postoperative pain after laparoscopic cholecystectomy. Surg Endosc2006; 20(3): 448–451.
21.
CepedaMSCarrDB.Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg2003; 97(5): 1464–1468.
22.
OğuzUŞahinTŞenocakÇ, et al. Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones. Turk J Urol2017; 43(3): 303–308.
23.
SternKLGaoTAntonelliJA, et al. Association of patient age and gender with kidney stone related quality of life. J Urol2019; 202(2): 309–313.
24.
LiatsikosENHomDDinlencCZ, et al. Tail stent versus re-entry tube: a randomized comparison after percutaneous stone extraction. Urology2002; 59(1): 15–19.
25.
LojanapiwatBSoonthornphanSWudhikarnS.Tubeless percutaneous nephrolithotomy in selected patients. J Endourol2001; 15(7): 711–713.
26.
IchaouiHSametABen HadjalouaneH, et al. Percutaneous nephrolithotomy (PCNL): standard technique versus tubeless - 125 procedures. Cureus2019; 11(3): e4251.
27.
YuanDLiuYRaoH, et al. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol2016; 30(7): 754–763.
28.
ThapaBBNiranjanV.Mini PCNL over standard PCNL: what makes it better?Surg J2020; 06(1): e19–e23.
