Ultrasound-Guided Paravertebral Block compare to the Intravenous Tramadol for Pain Control in Percutaneous Nephrolithotomy

Document Type : Editorial

Authors

1 Department of Medicine, Jiroft University of Medical Sciences, Tehran, Iran

2 Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

< p>Percutaneous nephrolithotomy (PCNL) is a standard treatment method for large choroidal stones with a shorter hospital stay than surgical procedures. After PCNL, a nephrostomy tube is placed for better discharge urine, prevent bleeding, and allow for further possible operations, which is can be the major cause of pain and discomfort for the patient. Paravertebral block (PVB) is a successful, non-complicating local anesthetic that is used in many surgical procedures to manage pain. It is suggested that the use of PVB in reducing pain after PCNL has had good results. In the previous study, the important problem of post-PCNL pain reduction has been properly managed by the PVB method and its high efficacy contrary to tramadol has been demonstrated. Evaluation of the PVB method is a good choice in this regard, but the question arises as to why Tramadol is selected as a method compared to PVB.

Highlights

  • Percutaneous nephrolithotomy (PCNL) is the standard stone treatment method.
  • Intravenous tramadol is good candidate for pain control in percutaneous nephrolithotomy.
  • Post-operative PCNL pain can cease by non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. 

Keywords


Editorial: Percutaneous nephrolithotomy (PCNL) is a standard treatment method for large choroidal stones (over 2 and a half centimeters) with a shorter hospital stay than surgical procedures (1, 2). After PCNL, a nephrostomy tube is placed for better discharge urine, prevent bleeding, and allow for further possible operations, which is can be the major cause of pain and discomfort for the patient. The resulting pain, in addition to the patient’s discomfort and dissatisfaction, can lead to cardiovascular and cardiovascular problems for the patient (3, 4). Therefore, it is important to employ appropriate methods to reduce pain and managing the pain after PCNL in the best way.
The effective treatment of postoperative pain can reduce complications, hospital stay, recovery time, and costs (5). The most common treatment to reduce post-operative PCNL pain is the use of non-steroidal anti-inflammatory drugs (NSAIDs) or opioids that can be linked with some side effects (6, 7). Therefore, alternative approaches such as the use of topical pain reduction can be a good alternative to opioids and NSAIDs. Paravertebral block (PVB) is a successful, non-complicating local anesthetic that is used in many surgical procedures to manage pain (8-10). It is suggested that the use of PVB in reducing pain after PCNL has had good results (5). 
In the research by Hatipoglu et al., the important problem of post-PCNL pain reduction has been properly managed by the PVB method and its high efficacy contrary to opioids (tramadol) has been demonstrated (11). Evaluation of the PVB method is a good choice in this regard, which is appreciated by the authors, but the question arises as to why tramadol is selected as a method compared to PVB.
Also, given the adverse effects of tramadol (such as nausea, seizure, and serotonin syndrome) and its significant interactions with other drugs, several issues remain unclear in this study. Because tramadol reduces pain through reuptake inhibition of serotonin and norepinephrine and can have similar effects to antidepressants such as Venlafaxine (12). Two major side effects of tramadol, seizures, and serotonin syndrome, are increased when tramadol and antidepressants are used concomitantly (13). Thus, because Hatipoglu et al., did not address these exclusion factors, the ambiguity of tramadol use would be more pronounced, and the authors would feel strongly left blank if the authors included these in the study.
 
Authors’ contributions
VSH was responsible for the study conception and design.   RM wrote the manuscript.
 
Acknowledgments 
Special thanks to Urology Research Center (URC), Tehran University of Medical Sciences.
 
Conflict of interest
The authors declare, there is no conflict of interest.
 
Funding
There is no funding for this article.
 
Ethical statement
Not Applicable.
 
Data availability
Not Applicable.
 
Abbreviations
PCNL       Percutaneous nephrolithotomy
PVB         Paravertebral block
NSAIDs   Non-steroidal anti-inflammatory drugs
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