Objective: To determine the most optimum bupivacaine therapy after a ureteroscopic stone fragmentation.
Methodology: One hundred consecutive patients at Asian Institute of Medical and Health Sciences between May 2017 to October 2019 who underwent uncomplicated ureteroscopic intracorporeal lithotripsy participated in this study. The patients had stone size between 5-12mm. Ureteroscopy was carried out with 8.5 F rigid endoscope, where pneumatic lithotripter was used as the source of energy. Patients had stent and bupivacaine instillation or only ureteric bupivacaine. All patients were evaluated for supra pubic and flank pain, symptoms of irritation, peritonism, analgesic use frequency, infection of urinary tract, hospitalization duration, post discharge analgesic usage, post discharge visit (due to renal colic), readmission and residual stones.
Results: Patients with both stent and bupivacaine instillation, only one patient had moderate pain while five patients reported only mild pain. Combination of instillation of bupivacaine and stent placement had relatively lower frequency of urinary tract symptoms at one-week postoperative follow-up (p=0.001).
Conclusion: A combination of bupivacaine instillation and stent placement lowered the frequency of postoperative pain among patients undergoing ureteroscopy. However, a thorough exploration with longitudinal studies is needed to ensure the efficacy of such interventions and improve patient outcome, postoperatively.
Key words: Bupivacaine instillation, postoperative pain, ureteroscopic stone fragmentation.
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