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HF 8084

Bupivacaine Injection into the Kidney

Why do I need this procedure?

Some patients have bleeding from their kidney or pain around the kidney that is part of a group of symptoms called Loin Pain Hematuria Syndrome (LPHS). Injection of a numbing medicine (bupivacaine) into the kidney may help your transplant doctor figure out whether you have LPHS and what to do about it.

How is this procedure done?

The doctor will place a small needle through your skin and into your right or left kidney. The doctor will then inject a small dose of a numbing medicine. We will watch you afterwards to see how you respond. 

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The procedure is done using:

Ultrasound: uses sound waves to create pictures of your organs and record the location of the kidney.

Fluoroscopy: an exam of your organs using x-rays after contrast is injected into the kidney.

Before the injection, an Interventional Radiologist will explain what is going to happen and will ask for your consent. Please tell the doctor if you have any allergies to contrast dye, antibiotics, anesthetic (numbing) agents, latex, or any other medicines.

What can I expect during the procedure? 

The procedure is done as an outpatient. You will arrive about an hour before the procedure. The procedure will take about 90 minutes. You will recover for about 2 hours. You will not need to stay overnight in the hospital unless there are problems after the procedure. 

We will place an IV in your hand or arm to give you a small dose of medicine for pain and to relax you. We will also give you an IV antibiotic to lower the risk of infection. 

We will ask you to lay on your belly on the procedure table. The doctor will use ultrasound over your skin to look at your kidney. The doctor will mark a spot on your lower back with a marker. This helps plan where the needle will go in. After marking this area, we will clean the skin. We will place a sterile drape over your back and legs. The doctors will put on sterile gowns and gloves and wear masks.

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The RN will give you a small dose of medicine through your IV to relieve the pain and help you relax. We will numb the skin over your kidney. The doctor will then advance the needle into your kidney. Most of the time, patients do not feel much pain, but you may feel pressure. When the needle is in place, we will inject a small amount of x-ray dye to make sure that the needle is in the right place in your kidney. Then, we will slowly inject the bupivacaine into the kidney. The doctor will ask you to rate your pain on a scale of zero (no pain) to ten (very severe pain). 

We may give you medicine during the procedure to make it easier to see your kidney. This medicine may cause you to feel like you need to urinate. It is okay to let the care team know if you are having trouble holding your urine at this point.

After we inject all the bupivacaine, the needle will be removed. We will place a dressing over the puncture site. You will go to the recovery area where the nurse will watch you closely for about 2 hours.

During Your Recovery

You will return to the prep/recovery area. The nursing staff will be checking your vital signs and needle puncture site. It is normal if your urine appears blood tinged. You should tell the nursing staff if you:

  • Feel nauseated or vomit

  • Feel like you have a fever or have chills

  • Have severe pain where the needle went in

  • Have trouble breathing

Home Care

  • Do not lift more than 10 lbs. 

  • No strenuous activity for 48 hours.

  • Remove dressing over puncture site in 48 hours.

Pain Management 

You will have some pain. This pain often goes away in 24 to 48 hours. 

For mild to moderate pain, take 1-2 acetaminophen (Tylenol®) tablets or 1-2 ibuprofen tablets every 6 hours as needed.

For moderate to severe pain, take the strong pain medicine that we prescribed for you. If you do not have any we will give you a prescription for a small supply. These pain medicines may make you sleepy. Do not drive if you are taking them. 

When to Call 

Call Interventional Radiology if you have any of these symptoms:

  • Redness at the site bigger than an inch

  • New swelling at the site

  • A temperature greater than 100.5° F for two readings taken 4 hours apart

  • Shaking chills

  • Foul-smelling urine

  • Pain at the needle site after 24 hours

  • Pain in your side

Follow-Up

We will ask you to track and record your pain. Your UW transplant coordinator will tell you how to do this. 

We will see you in the transplant clinic the next day to review your past medical history and your response to the procedure.

Phone Numbers

Call if you have any questions or problems once you are at home. 

Radiology Department, Monday through Friday, 8:00 am to 4:30 pm at (608) 263-9729, option #3.

Nights, weekends, and holidays call (608) 262-2122. This will give you the paging operator. Ask for the Interventional Radiologist on call. Give your name and phone number with the area code. The doctor will call you back.

If you live out of the area, please call 1-800-323-8942.

If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.