Abstract
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.
Highlights
Percutaneous nephrolithotomy (PCNL) is a minimally invasive endourological procedure used to manage patients with large, multiple, and staghorn renal calculi [1]
Clinicians have reported that peritubal (PT) infiltration of the nephrostomy tract with an anesthetic can reduce post-operative pain [6]
Bupivacaine and ropivacaine were used for the intercostal nerve block (ICNB)
Summary
Percutaneous nephrolithotomy (PCNL) is a minimally invasive endourological procedure used to manage patients with large, multiple, and staghorn renal calculi [1]. Significant post-operative pain can occur with PCNL in the first 24 h along the nephrostomy tract or due to dilatation of the renal capsule and parenchyma. Regional anesthesia offers the advantage of direct action at the site of surgery with minimal adverse effects of analgesic drugs. Clinicians have reported that peritubal (PT) infiltration of the nephrostomy tract with an anesthetic can reduce post-operative pain [6]. Paravertebral, and intercostal nerve block (ICNB) are commonly used to provide post-operative pain relief after PCNL [7, 8]. We aimed to assess the efficacy of intercostal nerve block (ICNB) for pain relief after percutaneous nephrolithotomy (PCNL)
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