Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial
Purpose To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL). Materials and methods This is a prospective randomized double‐blinded placebo‐controlled trial. In all, 140 consecutive patien...
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| Veröffentlicht in: | International journal of urology 2022-12, Vol.29 (12), p.1535-1542 |
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| container_title | International journal of urology |
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| creator | El‐Shaer, Waleed Haggag, Mohamed Salah Elshaer, Alaa Shaboob, Islam Kandeel, Wael Elmohamady, Basheer Abdelmotaleb, Dina Saad Abdel‐Lateef, Sally |
| description | Purpose
To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL).
Materials and methods
This is a prospective randomized double‐blinded placebo‐controlled trial. In all, 140 consecutive patients underwent PCNL for the management of large renal calculi. They were randomly assigned (1:1) to one of either study groups, the NE‐PCNL group (70 patients whose PCNL‐trajectory was infiltrated by NE) or the Placebo group (saline PCNL) (70 patients whose PCNL tracts were infiltrated by normal saline). Procedure‐related blood loss (the primary outcome) was assessed and statistically analyzed. Also, all other procedure‐related events and complications were recorded and compared.
Results
The median blood loss was 378 ml (IQR: 252–504) in the NE‐PCNL group versus 592 ml (IQR: 378–756) in the S‐PCNL group (p |
| doi_str_mv | 10.1111/iju.15036 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2713310663</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2713310663</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3776-a682cd587bf04dfc20b76ba9db9fb85724eb292883d685711ac7af86615d01a73</originalsourceid><addsrcrecordid>eNp10c1qFTEYBuAgij1WF70BCbipi2nzM5NkVqUc1FYKbux6yN-0OWSSMZMgx1UvQfAOvRJjp3VRMIvkCzx5SfIBcITRCa7j1O3KCe4QZc_ABrctaQhqyXOwQT3uG4E5OQCvlmWHEKYEi5fggDLUt4LgDfi1lQHmJHdW55j2MMT0--6nnV2w822qM3RhdL6K7GKAyZqiLVQ-RgN9XBZoSlU3cLZJlyyDjWWB92ejd_k25jjtz-A5NLEob2u08i4Ya2CSwcTJ_ailjiFX7muZk5P-NXgxSr_YNw_rIbj--OHr9qK5-vLpcnt-1WjKOWskE0SbTnA1otaMmiDFmZK9Uf2oRMdJaxXpiRDUsLrFWGouR8EY7gzCktNDcLzmzil-K3bJw-QWbb1fnzEQjinFiDFa6bsndBdLCvV2VXVtR3vU9lW9X5VO9WuSHYc5uUmm_YDR8LdTQ-3UcN-pat8-JBY1WfNPPramgtMVfHfe7v-fNFx-vl4j_wCNAqKX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2754539049</pqid></control><display><type>article</type><title>Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial</title><source>MEDLINE</source><source>Wiley Journals</source><creator>El‐Shaer, Waleed ; Haggag, Mohamed Salah ; Elshaer, Alaa ; Shaboob, Islam ; Kandeel, Wael ; Elmohamady, Basheer ; Abdelmotaleb, Dina Saad ; Abdel‐Lateef, Sally</creator><creatorcontrib>El‐Shaer, Waleed ; Haggag, Mohamed Salah ; Elshaer, Alaa ; Shaboob, Islam ; Kandeel, Wael ; Elmohamady, Basheer ; Abdelmotaleb, Dina Saad ; Abdel‐Lateef, Sally</creatorcontrib><description>Purpose
To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL).
Materials and methods
This is a prospective randomized double‐blinded placebo‐controlled trial. In all, 140 consecutive patients underwent PCNL for the management of large renal calculi. They were randomly assigned (1:1) to one of either study groups, the NE‐PCNL group (70 patients whose PCNL‐trajectory was infiltrated by NE) or the Placebo group (saline PCNL) (70 patients whose PCNL tracts were infiltrated by normal saline). Procedure‐related blood loss (the primary outcome) was assessed and statistically analyzed. Also, all other procedure‐related events and complications were recorded and compared.
Results
The median blood loss was 378 ml (IQR: 252–504) in the NE‐PCNL group versus 592 ml (IQR: 378–756) in the S‐PCNL group (p < 0.0001). In addition, Hemoglobin and Hematocrit deficits were lower in NE‐PCNL (p < 0.05). Patients who were randomized to the NE‐PCNL group had a higher immediate stone‐free rate (SFR) (80%) compared with those of the S‐PCNL group (70%) (p = 0.034). However, no statistical differences were found in the final SFR. The reported overall complications between the 2 groups were similar (p > 0.05). Indeed, bleeding‐related complications were 1 (1.4%) versus 10 (14.3%) for NE‐PCNL and S‐PCNL, respectively (p = 0.009).
Conclusions
Trajectory infiltration of PCNL tracts by NE was found to be effective and safe in mitigation of PCNL‐related blood loss. This step is a timeless and cost‐effective as NE is readily available in surgical theaters and of very low cost.</description><identifier>ISSN: 0919-8172</identifier><identifier>EISSN: 1442-2042</identifier><identifier>DOI: 10.1111/iju.15036</identifier><identifier>PMID: 36094821</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Blood ; blood loss ; Calcification (ectopic) ; Epinephrine ; Hematocrit ; Hemoglobin ; Humans ; Infiltration ; Kidney Calculi - surgery ; Nephrolithiasis ; Nephrolithotomy, Percutaneous - adverse effects ; Nephrostomy, Percutaneous - adverse effects ; Norepinephrine ; PCNL ; Placebos ; Prospective Studies ; renal stones ; stone free rate ; Treatment Outcome ; Urological surgery</subject><ispartof>International journal of urology, 2022-12, Vol.29 (12), p.1535-1542</ispartof><rights>2022 The Japanese Urological Association.</rights><rights>2022 The Japanese Urological Association</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3776-a682cd587bf04dfc20b76ba9db9fb85724eb292883d685711ac7af86615d01a73</citedby><cites>FETCH-LOGICAL-c3776-a682cd587bf04dfc20b76ba9db9fb85724eb292883d685711ac7af86615d01a73</cites><orcidid>0000-0003-4337-9375</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fiju.15036$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fiju.15036$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36094821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>El‐Shaer, Waleed</creatorcontrib><creatorcontrib>Haggag, Mohamed Salah</creatorcontrib><creatorcontrib>Elshaer, Alaa</creatorcontrib><creatorcontrib>Shaboob, Islam</creatorcontrib><creatorcontrib>Kandeel, Wael</creatorcontrib><creatorcontrib>Elmohamady, Basheer</creatorcontrib><creatorcontrib>Abdelmotaleb, Dina Saad</creatorcontrib><creatorcontrib>Abdel‐Lateef, Sally</creatorcontrib><title>Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial</title><title>International journal of urology</title><addtitle>Int J Urol</addtitle><description>Purpose
To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL).
Materials and methods
This is a prospective randomized double‐blinded placebo‐controlled trial. In all, 140 consecutive patients underwent PCNL for the management of large renal calculi. They were randomly assigned (1:1) to one of either study groups, the NE‐PCNL group (70 patients whose PCNL‐trajectory was infiltrated by NE) or the Placebo group (saline PCNL) (70 patients whose PCNL tracts were infiltrated by normal saline). Procedure‐related blood loss (the primary outcome) was assessed and statistically analyzed. Also, all other procedure‐related events and complications were recorded and compared.
Results
The median blood loss was 378 ml (IQR: 252–504) in the NE‐PCNL group versus 592 ml (IQR: 378–756) in the S‐PCNL group (p < 0.0001). In addition, Hemoglobin and Hematocrit deficits were lower in NE‐PCNL (p < 0.05). Patients who were randomized to the NE‐PCNL group had a higher immediate stone‐free rate (SFR) (80%) compared with those of the S‐PCNL group (70%) (p = 0.034). However, no statistical differences were found in the final SFR. The reported overall complications between the 2 groups were similar (p > 0.05). Indeed, bleeding‐related complications were 1 (1.4%) versus 10 (14.3%) for NE‐PCNL and S‐PCNL, respectively (p = 0.009).
Conclusions
Trajectory infiltration of PCNL tracts by NE was found to be effective and safe in mitigation of PCNL‐related blood loss. This step is a timeless and cost‐effective as NE is readily available in surgical theaters and of very low cost.</description><subject>Blood</subject><subject>blood loss</subject><subject>Calcification (ectopic)</subject><subject>Epinephrine</subject><subject>Hematocrit</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Infiltration</subject><subject>Kidney Calculi - surgery</subject><subject>Nephrolithiasis</subject><subject>Nephrolithotomy, Percutaneous - adverse effects</subject><subject>Nephrostomy, Percutaneous - adverse effects</subject><subject>Norepinephrine</subject><subject>PCNL</subject><subject>Placebos</subject><subject>Prospective Studies</subject><subject>renal stones</subject><subject>stone free rate</subject><subject>Treatment Outcome</subject><subject>Urological surgery</subject><issn>0919-8172</issn><issn>1442-2042</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10c1qFTEYBuAgij1WF70BCbipi2nzM5NkVqUc1FYKbux6yN-0OWSSMZMgx1UvQfAOvRJjp3VRMIvkCzx5SfIBcITRCa7j1O3KCe4QZc_ABrctaQhqyXOwQT3uG4E5OQCvlmWHEKYEi5fggDLUt4LgDfi1lQHmJHdW55j2MMT0--6nnV2w822qM3RhdL6K7GKAyZqiLVQ-RgN9XBZoSlU3cLZJlyyDjWWB92ejd_k25jjtz-A5NLEob2u08i4Ya2CSwcTJ_ailjiFX7muZk5P-NXgxSr_YNw_rIbj--OHr9qK5-vLpcnt-1WjKOWskE0SbTnA1otaMmiDFmZK9Uf2oRMdJaxXpiRDUsLrFWGouR8EY7gzCktNDcLzmzil-K3bJw-QWbb1fnzEQjinFiDFa6bsndBdLCvV2VXVtR3vU9lW9X5VO9WuSHYc5uUmm_YDR8LdTQ-3UcN-pat8-JBY1WfNPPramgtMVfHfe7v-fNFx-vl4j_wCNAqKX</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>El‐Shaer, Waleed</creator><creator>Haggag, Mohamed Salah</creator><creator>Elshaer, Alaa</creator><creator>Shaboob, Islam</creator><creator>Kandeel, Wael</creator><creator>Elmohamady, Basheer</creator><creator>Abdelmotaleb, Dina Saad</creator><creator>Abdel‐Lateef, Sally</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4337-9375</orcidid></search><sort><creationdate>202212</creationdate><title>Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial</title><author>El‐Shaer, Waleed ; Haggag, Mohamed Salah ; Elshaer, Alaa ; Shaboob, Islam ; Kandeel, Wael ; Elmohamady, Basheer ; Abdelmotaleb, Dina Saad ; Abdel‐Lateef, Sally</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3776-a682cd587bf04dfc20b76ba9db9fb85724eb292883d685711ac7af86615d01a73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Blood</topic><topic>blood loss</topic><topic>Calcification (ectopic)</topic><topic>Epinephrine</topic><topic>Hematocrit</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Infiltration</topic><topic>Kidney Calculi - surgery</topic><topic>Nephrolithiasis</topic><topic>Nephrolithotomy, Percutaneous - adverse effects</topic><topic>Nephrostomy, Percutaneous - adverse effects</topic><topic>Norepinephrine</topic><topic>PCNL</topic><topic>Placebos</topic><topic>Prospective Studies</topic><topic>renal stones</topic><topic>stone free rate</topic><topic>Treatment Outcome</topic><topic>Urological surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>El‐Shaer, Waleed</creatorcontrib><creatorcontrib>Haggag, Mohamed Salah</creatorcontrib><creatorcontrib>Elshaer, Alaa</creatorcontrib><creatorcontrib>Shaboob, Islam</creatorcontrib><creatorcontrib>Kandeel, Wael</creatorcontrib><creatorcontrib>Elmohamady, Basheer</creatorcontrib><creatorcontrib>Abdelmotaleb, Dina Saad</creatorcontrib><creatorcontrib>Abdel‐Lateef, Sally</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>El‐Shaer, Waleed</au><au>Haggag, Mohamed Salah</au><au>Elshaer, Alaa</au><au>Shaboob, Islam</au><au>Kandeel, Wael</au><au>Elmohamady, Basheer</au><au>Abdelmotaleb, Dina Saad</au><au>Abdel‐Lateef, Sally</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial</atitle><jtitle>International journal of urology</jtitle><addtitle>Int J Urol</addtitle><date>2022-12</date><risdate>2022</risdate><volume>29</volume><issue>12</issue><spage>1535</spage><epage>1542</epage><pages>1535-1542</pages><issn>0919-8172</issn><eissn>1442-2042</eissn><abstract>Purpose
To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL).
Materials and methods
This is a prospective randomized double‐blinded placebo‐controlled trial. In all, 140 consecutive patients underwent PCNL for the management of large renal calculi. They were randomly assigned (1:1) to one of either study groups, the NE‐PCNL group (70 patients whose PCNL‐trajectory was infiltrated by NE) or the Placebo group (saline PCNL) (70 patients whose PCNL tracts were infiltrated by normal saline). Procedure‐related blood loss (the primary outcome) was assessed and statistically analyzed. Also, all other procedure‐related events and complications were recorded and compared.
Results
The median blood loss was 378 ml (IQR: 252–504) in the NE‐PCNL group versus 592 ml (IQR: 378–756) in the S‐PCNL group (p < 0.0001). In addition, Hemoglobin and Hematocrit deficits were lower in NE‐PCNL (p < 0.05). Patients who were randomized to the NE‐PCNL group had a higher immediate stone‐free rate (SFR) (80%) compared with those of the S‐PCNL group (70%) (p = 0.034). However, no statistical differences were found in the final SFR. The reported overall complications between the 2 groups were similar (p > 0.05). Indeed, bleeding‐related complications were 1 (1.4%) versus 10 (14.3%) for NE‐PCNL and S‐PCNL, respectively (p = 0.009).
Conclusions
Trajectory infiltration of PCNL tracts by NE was found to be effective and safe in mitigation of PCNL‐related blood loss. This step is a timeless and cost‐effective as NE is readily available in surgical theaters and of very low cost.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36094821</pmid><doi>10.1111/iju.15036</doi><tpages>1542</tpages><orcidid>https://orcid.org/0000-0003-4337-9375</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0919-8172 |
| ispartof | International journal of urology, 2022-12, Vol.29 (12), p.1535-1542 |
| issn | 0919-8172 1442-2042 |
| language | eng |
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| source | MEDLINE; Wiley Journals |
| subjects | Blood blood loss Calcification (ectopic) Epinephrine Hematocrit Hemoglobin Humans Infiltration Kidney Calculi - surgery Nephrolithiasis Nephrolithotomy, Percutaneous - adverse effects Nephrostomy, Percutaneous - adverse effects Norepinephrine PCNL Placebos Prospective Studies renal stones stone free rate Treatment Outcome Urological surgery |
| title | Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial |
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