Effects of vacuum-assisted access sheath in mini-percutaneous nephrolithotomy on early postoperative pain and analgesic requirement: a retrospective analysis

BACKGROUND/OBJECTIVES: This study aimed to evaluate the effect of vacuum-assisted access sheath use during mini-percutaneous nephrolithotomy (mini-PCNL) on early postoperative pain intensity and analgesic requirements in the treatment of renal pelvic stones. METHODS: A total of 150 patients who underwent mini-PCNL for a single renal pelvic stone ≥ 20 mm were retrospectively included. Patients who underwent standard mini-PCNL were classified as Group 1, while those treated with a vacuum-assisted access sheath were assigned to Group 2. Demographic characteristics, perioperative parameters, pain assessed by visual analog scale (VAS), and analgesic requirements were compared between the groups. RESULTS: The two groups were comparable in terms of mean age, body mass index, comorbidity status, ASA scores, degree of hydronephrosis, distance between skin puncture, fluoroscopy time, stone size, and stone density (p > 0.05). Operative time and length of hospital stay were significantly longer in Group 1 (77.97 ± 15.72 min and 3.28 ± 1.56 days, respectively) compared with Group 2 (p < 0.001). The incidence of high-grade fever and urinary tract infections requiring additional antibiotic therapy was significantly higher in Group 1 (p = 0.044 and p = 0.032, respectively). Hemoglobin decrease was also more pronounced in Group 1 (p < 0.001). Postoperative VAS scores were significantly lower in Group 2 than in Group 1 (p < 0.001). The absolute between-group differences in VAS at rest were 1.37 points at 1 h, 1.68 points at 6 h, and 1.81 points at 24 h. For dynamic VAS, the corresponding absolute differences were 2.38, 2.09, and 2.05 points, respectively. Furthermore, the number of patients requiring rescue analgesia was markedly higher in Group 1 (p < 0.001). In addition, Group 1 demonstrated a shorter mean time to rescue analgesia and higher analgesic dosage compared with Group 2 (p = 0.002 and p = 0.019, respectively). In multivariate analysis, vacuum-assisted access sheath use remained an independent predictor of both lower postoperative pain scores and reduced analgesic requirement, with an approximately 90% reduction in the odds of rescue analgesia use after adjustment for operative time and intraoperative remifentanil consumption. CONCLUSION: Vacuum-assisted access sheath use was associated with lower early postoperative pain scores and reduced analgesic requirements; however, prospective controlled studies are needed to confirm these findings.