DOI: https://doi.org/10.21203/rs.3.rs-396652/v1
Backgroud and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing renal calculus ,but a large number of patients experience acute moderate-to-severe pain despite the analgesia provided.The aim of this study is to explore the risk factors for postoperative pain after percutaneous nephrolithotomy (PCNL), and provides a reference for clinical prevention of postoperative pain after PCNL.
Methods: According to the inclusion and exclusion criteria, the clinical data of 331 patients who underwent PCNL in our hospital from September 2019 to February 2021 were retrospectively collected. General anesthesia was induced with propofol, sufentanil and rocuronium and maintained with sevoflurane, remifentanil and rocuronium.Depending on whether the patient had moderate-to-severe postoperative pain, they were divided into mild or no pain group and moderate-to-severe pain group. We collected and analyzed data on age,gender, body mass index (BMI),ASA grading,co-morbidities,number of renal calculus,renal calculus size,degree of hydronephrosis,preoperative urine culture,preoperative creatinine,stone burdens,expansion method,tract diameter,nephrostomy tube,calculi residual,operative position ,puncture time ,number of expanded channels,expanded channel time, duration of surgery,vital signs and VAS pain score.The indicators with statistically significant differences were selected and multivariate logistic regression analysis was carried out to determine the risk factors for postoperative pain.
Results: Among 331 patients, 221 had moderate-to-severe pain and the incidence rate was 66.77%. Univariate analysis and multivariate logistic regression analysis showed that independent risk factors for moderate-to-severe pain after PCNL were:number of renal calculus(OR=5.303，P=0.001),stone burdens (OR=7.623，P=0.001),calculi residual(OR=0.2377，P=0.001),duration of surgery (min)(OR=1.024， P=0.001).
Conclusions: The main risk factors for pain after PCNL are number of renal calculus,stone burdens ,calculi residual and duration of surgery.
Table 1
Comparison of postoperative pain factors between the two groups
|
|
Mild or no pain Group(n=110) |
Moderate-to-severe pain group(n=220) |
P |
|
|
Gender,n |
Female |
39 |
83 |
0.709 |
|
Male |
71 |
138 |
|
|
|
Age,yr |
|
51.24±11.10 |
50.72±11.98 |
0.705 |
|
BMI,kg/m2 |
≤25 |
54 |
98 |
0.414 |
|
>25 |
56 |
123 |
|
|
|
ASA physical status,n |
I |
22 |
23 |
0.016 |
|
II |
88 |
198 |
|
|
|
Number of renal calculus,n |
1 |
70 |
5 |
<0.01 |
|
2 |
18 |
2 |
|
|
|
3 |
5 |
3 |
|
|
|
>3 |
17 |
211 |
|
|
|
Renal calculus size ,mm |
≤20 |
58 |
28 |
<0.01 |
|
20~40 |
52 |
138 |
|
|
|
＞40 |
0 |
55 |
|
|
|
Main composition of stone ,n |
Calcium oxalate monohydrate |
57 |
126 |
0.612 |
|
Carbonated apatite |
10 |
26 |
|
|
|
hydroxyapatite |
1 |
0 |
|
|
|
Uric acid stone |
20 |
32 |
|
|
|
Magnesium ammonium phosphate hexahydrate |
4 |
3 |
|
|
|
Struvite |
15 |
25 |
|
|
|
Cystine stone |
0 |
4 |
|
|
|
Calcium oxalate dihydrate |
3 |
3 |
|
|
|
Calcium hydrogen phosphate dihydrate |
0 |
1 |
|
|
|
Degree of hydronephrosis,n |
No |
71 |
83 |
<0.01 |
|
Mild |
39 |
115 |
|
|
|
Moderate |
0 |
17 |
|
|
|
Severe |
0 |
6 |
|
|
|
Preoperative urine culture,n |
Negative |
72 |
140 |
0.707 |
|
Positive |
38 |
81 |
|
|
|
Preoperative creatinine,umol/L |
Abnormal |
37 |
67 |
0.54 |
|
Normal |
73 |
154 |
|
|
|
Stone burdens,cm |
＜0 |
35 |
0 |
<0.01 |
|
1~2 |
46 |
41 |
|
|
|
>2 |
29 |
180 |
|
|
|
Expansion method,n |
Balloon Dilatation |
56 |
90 |
0.079 |
|
Two-step method Dilatation |
54 |
131 |
|
|
|
Tract diameter,Fr |
10Fr |
0 |
1 |
0.535 |
|
14Fr |
0 |
1 |
|
|
|
16Fr |
1 |
6 |
|
|
|
24Fr |
109 |
213 |
|
|
|
Calculi residual,n |
Stone free |
38 |
153 |
<0.01 |
|
Calculi residual |
72 |
68 |
|
|
|
Operative position,n |
Right kindney |
39 |
97 |
0.142 |
|
Left kindney |
71 |
124 |
|
|
|
Puncture time ,min |
|
207.55±43.19 |
213.23±39.77 |
0.235 |
|
Number of expanded channels,n |
|
1.09±0.32 |
1.22±0.47 |
0.009 |
|
Expanded channel time ,min |
|
204.55±38.37 |
214.42±41.41 |
0.037 |
|
Duration of surgery ,min |
|
90.21±31.70 |
117.41±47.06 |
0.001 |
|
BMI, body mass index;ASA, American Society of Anesthesiologists. |
||||
Table 2
Risk factors for moderate-to-severe postoperative pain in patients with PCNL
|
Risk factor |
SE |
Wald |
P Value |
OR |
|
Renal calculus size (mm) |
.587 |
6.295 |
.012 |
4.364 |
|
Number of renal calculus(n) |
.232 |
51.617 |
.001 |
5.303 |
|
Stone burdens(cm) |
.493 |
16.999 |
.001 |
7.623 |
|
Calculi residual(n) |
.522 |
7.595 |
.001 |
.237 |
|
Duration of surgery (min) |
.006 |
13.621 |
.001 |
1.024 |