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.

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 USG guided femoral nerve block vs fascia iliaca compartment block as post-operative analgesia in hip fracture patients

2018 ◽  
Vol 6 (9) ◽  
pp. 3057 ◽  
Author(s):  
Usha Shukla ◽  
Mizma Jahan ◽  
Shagufta Naaz ◽  
Swati Srivastava
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Nerve Block ◽  
Postoperative Analgesia ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
P Value ◽  
Analgesic Consumption ◽  
Group 3 ◽  
Fascia Iliaca Compartment Block

Background: Adequate postoperative analgesia facilitates early mobilization which is important to reduce postoperative morbidity. Here, we intended to compare the efficacy of two different nerve blocks for postoperative pain relief in fractured neck of femur patients.Methods: One hundred and five patients posted either for dynamic hip screw or proximal femoral nail implantation under spinal anaesthesia were randomly allocated to three groups. At the end of surgery, group 1 received femoral nerve block (FNB) and group 2 received fascia iliaca compartment block (FICB) for postoperative pain relief. These blocks were ultrasound guided. Group 3 received no block and acted as control. Patients’ pain was evaluated by Visual Analogue Scale (VAS) both at rest and at passive elevation of leg. Rescue analgesia was given when VAS score exceeded 3. Heart rate, mean arterial blood pressure, respiratory rate and total analgesic consumption in first 24 hours were also recorded.Results: Groups 1 and 2 had similar duration of analgesia of around 8 hours (P value = 0.727). Analgesic consumption in both these groups were similar (P value = 0.648). These groups had less pain, less analgesic requirement and more stable haemodynamics as compared to group 3. No adverse effect was seen due to application of block.Conclusions: FICB can be an effective alternative to femoral nerve block, because of its relative simplicity in technique and less invasiveness. Hence FICB holds considerable promise as an effective postoperative analgesia.

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

2013 ◽  
Vol 62 (12) ◽  
pp. 988-994 ◽  
Author(s):  
D. Ozkan ◽  
T. Akkaya ◽  
N. Karakoyunlu ◽  
E. Arık ◽  
J. Ergil ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Percutaneous Nephrolithotomy ◽  
Intercostal Nerve ◽  
Ultrasound Guided ◽  
Intercostal Nerve Block

scholarly journals Effect of Dexamethasone as an Adjuncton Efficacy of Ropivacaine in Caudal Block forPostoperative Analgesia in Paediatric Infra-Umbilical Surgeries: A Randomised Double-blind Controlled Study

2021 ◽  
Author(s):  
Veena Patodi ◽  
Kavita Jain ◽  
Mukesh Choudhary ◽  
Surendra Kumar Sethi ◽  
Neena Jain ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Controlled Study ◽  
P Value ◽  
Single Shot ◽  
Caudal Block ◽  
Analgesic Consumption ◽  
Pain Scores ◽  
Paediatric Patients ◽  
Haemodynamic Changes

Introduction: Caudal block is a routinely performed analgesic and anaesthetic technique in paediatric population undergoing various infra-umbilical surgeries. Various adjuvants have been used along with local anaesthetics like ropivacaine in single-shot caudal block for enhancing postoperative analgesia in paediatric infra-umbilical surgeries. Aim: To evaluate the efficacy of dexamethasone used as an adjuvant to 0.2% ropivacaine in caudal block for postoperative analgesia in paediatric patients. Materials and Methods: This was a randomised doubleblinded controlled study conducted on 80 paediatric patients (8 months-8 years), with American Society of Anesthesiologists (ASA) physical status I or II undergoing various infra-umbilical surgeries,at a tertiary care teaching institute from April 2019 to September 2019. These total subjects were randomly allocated into two groups. GroupR (n=40) administered 0.2% ropivacaine (1 mL/kg) while GroupRD (n=40) administered 0.2% ropivacaine (1 mL/kg) with dexamethasone (0.1 mg/kg) in caudal block. The duration of analgesia, postoperative pain scores (Face Legs Activity Cry Consolability (FLACC) score), rescue analgesic consumption in 24 hours, haemodynamic changes and side-effects were noted. The rescue analgesic (paracetamol 15 mg/kg oral) was given whenever FLACC ≥4. Standard qualitative and quantitative tests (unpaired student t-test, Chi-square test) were used to analyse and compare the results obtained. Results: The mean duration of analgesia was significantly longer in Group RD (745.21±146.91 min) as compared to GroupR (440.38±76.44 min); (p-value <0.001). The significantly lower FLACC pain scores were noted in patients in Group RD compared to Group R; (p-value <0.05). The rescue analgesic consumption was significantly lesser in Group RD in terms of requirement of number of doses of rescue analgesic than in Group R; (p-value <0.05). No significant haemodynamic changes or side-effects were observed in both groups; (p-value >0.05). Amongst postoperative complications noted, fever was observed in 1 patient (3.33%) and PONV in 2 patients (6.66%) in Group R. None complications were observed in the patients of RD group. Conclusion: Dexamethasone (0.1 mg/kg) was found to be safe and effective adjuvant to 0.2% ropivacaine for caudal block in children undergoing various infra-umbilical surgeries.

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