scholarly journals Analgesic efficacy of intercostal nerve block in percutaneous nephrolithotomy: systematic review and meta-analysis

2021 ◽  
Vol 8 (4) ◽  
pp. 586-593
Author(s):  
Gopal Sharma ◽  
Seema Prasad ◽  
Saket Singh ◽  
Yashasvi Thummala ◽  
Santosh Kumar
Keyword(s):  
Systematic Review ◽  
Nerve Block ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Intercostal Nerve ◽  
Control Group ◽  
Intercostal Nerve Block ◽  
Analgesic Requirement ◽  
Standard Mean Difference

Pain is important morbidity following percutaneous nephrolithotomy (PNL). Various adjunctive procedures such as intercostals nerve block (ICNB) have been described to reduce post-operative pain. The aim of this review was to determine the analgesic efficacy of ICNB in PNL patients. Systematic literature search was conducted to identify relevant publications. We followed preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines while conducting this review. In this review, five randomized studies with 319 patients were included. The analgesic requirement was statistically similar in ICNB and control group (Standard mean difference (SMD) -0.48 confidence interval (CI)[-1.4, 0.44] p=0.31) whereas analgesic requirement was lower for peritubal infiltration group (PTI) as compared to ICNB (SMD 0.85 CI[0.25,1.44] p=0.005). Also, time to first analgesic requirement was similar between ICNB and PTI (SMD 0.86 CI[-9.3,11.0]), p=0.87). Pain according to VAS (visual analog scale) and Dynamic VAS (DVAS) at 24 hours was lower in ICNB group as compared to the control group; however, only DVAS at 24 hours was statistically significant. DVAS and VAS at 24 hours were similar for both ICNB and PTI. Intercostal nerve block in terms of analgesic requirement appears to be inferior to peritubal block and no better than control group. Also, mean pain scores for ICNB were similar to control group and peritubal block.

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

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.

scholarly journals Effectiveness of Suprascapular Nerve Block in the Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yajing Hou ◽  
Yong Wang ◽  
Xiaojing Sun ◽  
Yake Lou ◽  
Ying Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Pain ◽  
Nerve Block ◽  
External Rotation ◽  
Meta Analysis ◽  
Suprascapular Nerve ◽  
Cochrane Library ◽  
Control Group ◽  
Suprascapular Nerve Block ◽  
Secondary Endpoints

Purpose: We aimed to investigate the effectiveness of suprascapular nerve block (SSNB) in patients with hemiplegic shoulder pain (HSP).Background: SSNB is widely used in various shoulder pains, but whether it is effective in HSP remains unknown.Methods: PubMed, Cochrane Library, and Embase databases were searched to identify potential citations. Randomized controlled trials meeting the eligible criteria were included in our analysis. The primary endpoint was Visual Analog Scale (VAS) with a maximum value of 100 and a minimum value of 0. Secondary endpoints were passive range of motion (PROM) that pain starts, and the PROM mainly included abduction, flexion, and external rotation. In addition, the upper extremity Fugl-Meyer assessment (FMA) was also included in our secondary endpoints.Results: Eight studies with 281 patients were included in our analysis. For VAS, there was no obvious difference between SSNB group and control group regardless of the follow-up period (<4 weeks or ≥4 weeks), which were −6.62 (−15.76, 2.53; p = 0.16) and 1.78 (−16.18, 19.74; p = 0.85). For shoulder function, the PROM of abduction, flexion, and external rotation was similar between groups. However, motor function indicator FMA is lower in SSNB control than that in control group, with a mean difference (and 95% CI) of −2.59 (−4.52, −0.66; p = 0.008).Conclusion: SSNB is an effective way for HSP patients.Systematic Review Registration: Registration ID: CRD42021252429.

scholarly journals Intercostal Nerve Block and Peritubal Infiltration with Bupivacaine for Postoperative Analgesia after Percutaneous Nephrolithotomy: A Randomised Clinical Study

2021 ◽  
Author(s):  
Karunakaran Binil ◽  
Kaniyil Suvarna ◽  
Kannammadathy Poulose Biji
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Percutaneous Nephrolithotomy ◽  
Postoperative Analgesia ◽  
Intercostal Nerve ◽  
Categorical Variables ◽  
P Value ◽  
Intercostal Nerve Block ◽  
Analgesic Consumption ◽  
Pain Scores

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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