Effect of ultrasound-guided intercostal nerve block on postoperative pain after percutaneous nephrolithotomy

Introduction: Percutaneous Nephrolithotomy (PCNL), a common endourologic procedure for removal of renal stones is associated with significant pain. Regional blocks are being used for postoperative analgesia after PCNL. Aim: To compare the analgesic efficacy of intercostal nerve block and fluoroscopic guided peritubal infiltration in terms of duration of analgesia, postoperative pain scores and total analgesic consumption in first 24 hours. Materials and Methods: This was a randomised clinical trial conducted from May 2018 to October 2018 on total of eighty patients, randomly allocated to two groups of 40 each. Group IC received intercostal nerve block and group IF received fluoroscopy guided peritubal infiltration with 0.25% bupivacaine. Duration of analgesia was assessed from postoperative pain scores (Numerical Rating Scale (NRS) during rest and coughing). Total analgesic consumption for 24 hours was also noted. Data was analysed using Chi-square test for categorical variables and independent Student’s t-test for quantitative variables. Results: The duration of analgesia was 702.00±140.022 minutes in Group IC and 346.50±129.566 minutes in group IF which was significant statistically with a p-value of <0.001. Resting and dynamic NRS were lower upto 12 hours postoperatively in group IC (p-value less than 0.05). Both tramadol (50.00±11.32 mg vs 82.50±24.15 mg) and paracetamol (100±303.82mg vs 850±622.23mg) requirements were lower in group IC as compared to group IF with p-values less than 0.001. Total consumption of first rescue analgesic tramadol as well as second analgesic Paracetamol both were significantly lesser(p-value<0.001) in group IC than group IF. Conclusion: Intercostal Nerve Block (INB) provided superior analgesia compared to fluoroscopic guided peritubal infiltration after PCNL.

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Efficacy of Intercostal Nerve Block for Pain Control After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.623605 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tao Chen ◽

ZhenQiang Zhu ◽

Jianlong Du

Keyword(s):

Postoperative Pain ◽

Nerve Block ◽

Percutaneous Nephrolithotomy ◽

Meta Analysis ◽

Intercostal Nerve ◽

Current Evidence ◽

Intercostal Nerve Block ◽

Analgesic Requirement ◽

Pain Scores ◽

Significant Difference

Background: We aimed to assess the efficacy of intercostal nerve block (ICNB) for pain relief after percutaneous nephrolithotomy (PCNL).Methods: An electronic search of the databases of PubMed, Science Direct, BioMed Central, CENTRAL, Embase, and Google Scholar was conducted. All types of studies conducted on adult patients undergoing PCNL, comparing ICNB with control or any other anesthetic method, and reporting postoperative pain outcomes were included.Results: Six studies were included. Studies compared ICNB with peritubal (PT) infiltration and with control. Pooled analysis of ICNB vs. PT infiltration indicated no difference between the two groups for pain scores at 6–8 h (MD −0.44; 95% CI −3.41, 2.53; I2 = 99%; p = 0.77), 12 h (MD −0.98; 95% CI −4.90, 2.94; I2 = 99%; p = 0.62) and 24 h (MD 0.16; 95% CI −0.90, 1.21; I2 = 88%; p = 0.77). Time for first analgesic demand was also not significantly different between the two groups. Meta-analysis of ICNB vs. control indicated statistical significant difference in pain scores between the two groups at 8 h (MD −1.55; 95% CI −2.60, −0.50; I2 = 47%; p = 0.04), 12 h (SMD −2.49; 95% CI −4.84, −0.13; I2 = 96%; p = 0.04) and 24 h (SMD −1.22; 95% CI −2.12, −0.32; I2 = 88%; p = 0.008). The total analgesic requirement in morphine equivalents was not significantly different between the two groups.Conclusions: ICNB may be effective in reducing postoperative pain after PCNL. However, its efficacy may not be greater than PT infiltration. Current evidence is from a limited number of studies. Further, high-quality randomized controlled trials are needed to provide robust evidence.

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