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Background and Aims: Catheter-related bladder discomfort (CRBD) causes significant distress to the patient and requires great attention to analgesia and increases morbidity in the postoperative period. This study evaluated the efficacy of intramuscular dexmedetomidine in alleviating CRBD following percutaneous nephrolithotomy (PCNL) and postoperative inflammatory response. Material and Methods: A prospective randomized double-blind study was conducted in a tertiary care hospital from December 2019- March 2020. Sixty seven of ASA I and II patients scheduled for elective PCNL were randomized and group I received 1 µg/kg dexmedetomidine intramuscularly and group II normal saline as control 30 minutes before induction of anesthesia. Standard anesthesia protocol was followed and patients were catheterized with 16 Fr Foleys after induction of anesthesia. Rescue analgesia was paracetamol if the score was moderate. Postoperatively CRBD score and inflammatory markers; total white cell count, erythrocyte sedimentation rate and temperature were noted for 3 days. Results: There was a significant low CRBD score in group I. Ramsay sedation score was 2 in group I with p 0.00 and rescue analgesia required was very low with p 0.00. Statistical Package for social Sciences software version 20 was used for analysis. Student ttest, analysis of variance, and Chisquare test were applied for quantitative and qualitative analysis respectively. Conclusion: Single dose intramuscular dexmedetomidine is effective, simple and safe in preventing the CRBD and the inflammatory response remained uninfluenced except ESR, the reason remains largely unknown.
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BACKGROUND AND AIMS: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for managing large renal calculi. Although minimally invasive, it is associated with pain due to dilatation of renal capsule, parenchymal tract, and nephrostomy tube placement. Gender differences in pain perception and analgesic requirement have not been studied in PCNL surgeries. This study was done to evaluate the influence of gender on pain. MATERIAL AND METHODS: It was a prospective observational study including 60 ASA physical status I and II patients. The number of males and females were 29 and 31, respectively. Analgesic requirement and postoperative pain score were assessed by visual and dynamic visual analog scales (VAS, DVAS) score fourth hourly for first 24 h. Rescue analgesia was IV paracetamol 1 g when pain score exceeded four. VAS scores were assessed using Mann-Whitney test. Rescue analgesia was calculated as frequency and proportions. A P value of <0.05 was considered statistically significant. RESULTS: The mean pain score values (VAS P = 0.361; DVAS P = 0.332) and postoperative fentanyl (P = 0.703) did not show a statistically significant difference in males and females. The requirement of rescue paracetamol was higher in females with 30 out of 31 females demanding a rescue analgesic in comparison to 15 out of 29 male patients (P = 0.001). CONCLUSION: No significant difference was observed in postoperative pain among males and females in patients undergoing PCNL surgery. The analgesic requirement, however, was found to be more in females than in males.
