A comparison of the efficacy of intercostal nerve block and peritubal infiltration of ropivacaine for post-operative analgesia following percutaneous nephrolithotomy: A prospective randomised double-blind study

Abstract

Background and Aims:Intercostal nerve blockade (ICNB) and peritubal infiltration of the nephrostomy tract are well-established regional anaesthetic techniques for alleviating pain after percutaneous nephrolithotomy (PCNL). This prospective study compared the efficacy of ICNB and peritubal local anaesthetic infiltration of the nephrostomy tract in providing post-operative analgesia following PCNL.Methods:Sixty American Society of Anesthesiologist physical status 1 and II patients scheduled for PCNL requiring nephrostomy tube were randomised to receive either peritubal infiltration or ICNB. At the completion of the procedure, patients in Group P received peritubal infiltration and those in Group I received ICNB at 10, 11, 12th spaces using fluoroscopy guidance. Postoperatively, patients were followed for 24 h for pain using Visual Analogue Scale (VAS) and Dynamic VAS. Rescue analgesia was inj. tramadol 1 mg/kg IV when pain score exceeded 4. Time to first rescue analgesia, number of doses and patient's satisfaction were noted in all patients.Results:Pain scores were lower in the group I at all points of measurement than group P. The mean time to first demand for rescue analgesia was higher in Group I (13.22 ± 4.076 h vs 7.167 ± 3.92 h P - 0.001). The number of demands and the amount of analgesics consumed were less in Group I.Conclusion:ICNB provided superior analgesia as evidenced by longer time to first demand of analgesic, reduced number of demands and consumption of rescue analgesic. Peritubal infiltration, although less efficacious, may be a safe and simple alternative technique.

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

“…Bupivacaine and ropivacaine were used for the ICNBs. Two studies ( 7 , 18 ) compared ICNB with PT infiltration, three ( 13 , 20 , 21 ) compared with control while one study ( 19 ) was a three-arm trial including ICNB, PT infiltration, and control. All studies administered ICNB after the procedure, except for Ozkan et al ( 20 ).…”

“…The authors' assessment of the risk of bias in the included studies is presented in Figure 6 . Adequate methods of randomization were described in four studies ( 7 , 18 – 20 ). Appropriate methods of blinding of both participants and outcome assessors were reported by two studies ( 19 , 20 ).…”

“…Appropriate methods of blinding of both participants and outcome assessors were reported by two studies ( 19 , 20 ). Reporting bias was low with the three RCTs ( 7 , 18 , 20 ) which were pre-registered.…”

“…Studies have reported that smaller tubes are associated with reduced pain ( 31 , 32 ). In the study of Jonnavithula et al ( 18 ) smaller bore sizes were used as opposed to 24 F tube size in the study of Singh et al ( 7 ). Choi et al ( 19 ) conducted their study on tubeless PCNL.…”

Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial

“…Jonnavithula et al . [16] demonstrated a higher TAR, a lower time duration for demand of analgesia, and a raised VAS in PTB group as compared to ICNB group (7.167 ± 3.92 vs. 13.22 ± 4.07 h) with ropivacaine.…”