Bupivacaine for Pain Control in Nephrostomy Tube Insertion

Nephrostomy tube placement involves inserting a small tube through the skin and soft tissues into the kidney's collecting system to provide external drainage of urine when flow to the bladder is obstructed. A local anesthetic is injected along the nephrostomy tract and adjacent to the renal capsule to provide pain relief during the procedure.

Published medical literature predominantly describes lidocaine as the medication of choice for perirenal local anesthesia. However, no professional society guideline mandating a specific local anesthetic as the "standard of care" for nephrostomy tube placement was identified in the literature. In clinical practice, lidocaine is predominantly used.

Bupivacaine is a longer-acting alternative to lidocaine that may provide more sustained post-procedure pain relief. Use of bupivacaine has been well established in other procedural settings such as laparoscopic trocar-site infiltration (commonly performed by general surgery and gynecology) and nephrostomy-tract infiltration during percutaneous nephrolithotomy (performed by urologists).

A small subset of interventional radiologists in the Edmonton Zone-informally estimated at 2 out of 10-use bupivacaine for perirenal local anesthesia during percutaneous nephrostomy tube placement. These interventional radiologists anecdotally report better post-procedure pain control than with lidocaine for perirenal anesthesia. However, bupivacaine use for perirenal local anesthesia during nephrostomy tube placement has not been formally studied.

Our study aims to determine whether bupivacaine, compared with lidocaine, reduces pain during early recovery when used for perinephric local anesthesia.

We propose a prospective, randomized, controlled study with single-blinded outcome assessment. Patients undergoing percutaneous nephrostomy tube insertion will be randomized to receive either lidocaine or bupivacaine for perinephric local anesthesia. Participants will rate their pain at scheduled intervals after the procedure. Pain assessments will be performed by the site's nurse coordinator, who will be blinded to the local anesthetic technique used for each patient. We will compare pain scores and additional analgesic requirements between the two groups.

We expect patients receiving bupivacaine to experience significantly better post-procedure pain control than those receiving lidocaine. The findings may guide local anesthetic selection and ultimately improve comfort during recovery from nephrostomy tube placement.