Drug Eases Post-Nephrolithotomy Pain

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Pentoxifylline infusion reduced need for narcotics, Iranian study finds.

Preoperative IV infusion of pentoxifylline (PTX) may help to reduce pain intensity and inflammatory changes in patients undergoing nephrolithotomy, data suggest.

Investigators at Tehran University of Medical Sciences in Iran studied 32 patients undergoing nephrolithotomy. Patients were randomized to receive IV PTX (500 mg in 500 mL saline for two hours followed by 700 mg in 1,000 mL saline for six hours) or placebo (1,500 mL saline) before induction of general anesthesia.

The two groups were comparable with regard to demographics and had similar clinical and laboratory characteristics. The researchers obtained two venous blood samples 10 minutes before PTX or placebo infusion and 24 hours after surgery. Following surgery, they evaluated narcotic use and pain intensity.

Narcotic use was more common in the placebo than the PTX arm, the authors reported in the Journal of Endourology (2009;23:323-328). The PTX-treated patients had significantly lower pain intensity compared with placebo recipients. They also had lower postoperative plasma levels of tumor necrosis factor-α and interleukin-6, both of which are proinflammatory cytokines.

The two groups were similar with respect to operating time, length of hospital stay, and development of postoperative fever during in-hospital follow-up. Five patients in the PTX group (31.2%) experienced nausea and vomiting.

The researchers concluded that their dosing regimen “was able to show clinical benefits by improving postoperative pain management and diminished narcotic analgesia consumption. In concordance with previous observations, our findings provide a firm rationale for the use of PTX in clinical trials of surgical interventions of the kidney.”
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