Vol.:(0123456789) 1 3 Urolithiasis DOI 10.1007/s00240-017-0971-4 ORIGINAL PAPER The efect of nephrostomy tract infltration of ketamine on postoperative pain and peak expiratory fow rate in patients undergoing tubeless percutaneous nephrolithotomy: a prospective randomized clinical trial Seyed Reza Hosseini 1,3  · Farsad Imani 2  · Golnar Shayanpour 2  · Mohammad Reza Khajavi 2   Received: 13 December 2016 / Accepted: 2 March 2017 © Springer-Verlag Berlin Heidelberg 2017 ketamine group p < 0.009. There was no signifcant difer- ences in PEF between the two groups in the postoperative period (p = 0.622). In conclusion infltration of ketamine into the nephrostomy tract provides superior analgesic and sedative efects in PCNL surgery without signifcant changes in PEF. Keywords Ketamine · Nephrolithotomy, percutaneous · Pain, postoperative · Peak expiratory fow rate Introduction Nowadays, percutaneous nephrolithotomy (PCNL) is a common method of removing renal stones. Although the incision is minimal, postoperative pain is an impor- tant problem in perioperative patient care. The release of infammatory mediators and excitatory amino acids follow- ing surgical procedures may cause powerful nociceptive impulses that trigger pain [1]. There are several methods such as intravenous opioids, multimodal analgesic regi- mens, and infltration of local anesthetic into the nephros- tomy tract to alleviate this problem [2–4]. Ketamine is an anesthetic and analgesic drug that antagonizes excitatory amino acids non-selectively to prevent central sensitization of nociceptors following noxious stimulation [5]. Ketamine has been recently used as a complimentary postoperative analgesic to reduce the mean pain score and opioid requirement after surgery [6–8]. In a previous study, we evaluated the analgesic efects of nephrostomy tract infltration of ketamine–bupivacaine after tubeless percu- taneous nephrolithotomy [9]. The results showed that this combination had a good efect on postoperative pain man- agement but cardiotoxicity is a concern. Abstract Ketamine, as a systemic and local analgesic, has been used to reduce postoperative pain in many stud- ies. The present study was designed to assess the analge- sic efcacy of nephrostomy tract infltration of ketamine in postoperative pain after tubeless percutaneous nephroli- thotomy (PCNL). Sixty-six patients with renal stone who were candidates for PCNL were randomized to two groups with 33 patients in each group. In group K, 20 mL saline solution containing 1.5 mg/kg ketamine was infltrated into the nephrostomy tract and in group C, 20 mL saline solu- tion was infltrated into the nephrostomy tract at the end of surgery. The postoperative pain scores, sedation scores, time to frst rescue analgesia, rescue analgesic require- ment, peak expiratory fow rate (PEF), and hemodynamic parameters were compared between two groups. Sixty-six patients with a mean age of 45.29 ± 15 years and an age range of 18–60 years participated in this study. There was no signifcant diference in the demographic data and dura- tion of surgery between the two groups. The mean VAS scores were signifcantly lower in the intervention group compared with the control group at the recovery, and 4 and 6 h postoperatively (p = 0.001). The mean time to frst res- cue analgesia in the postoperative period was signifcantly lower in the control group (64.5 ± 8.1 min) compared with the intervention group (122 ± 18.4 min). The trend of frst opioid administration was signifcantly lower in the * Seyed Reza Hosseini rhosseinim@yahoo.com 1 Department of Urology, Tehran University of Medical Sciences, Tehran, Iran 2 Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran 3 Sina Hospital, Hasanabad St., Tehran, Iran