Paravertebral block reduces pain in elderly patients with percutaneous nephrolithotomy

Deng, Jun; Wei, Ke; Li, Mingliang; Wang, Xiaoping; Tang, Qianli

doi:10.1097/md.0000000000023761

Cited by 1 publication

(1 citation statement)

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“…In a comparative study as early as 1993, continuous PVB showed better postoperative pain relief than continuous epidural block after renal surgery ( 32 ). In recent years, clinical studies indicated that PVB can be used for postoperative analgesia in patients undergoing renal surgery ( 33 ). Saroa et al ( 34 ) reported that ipsilateral PVB guided by a single ultrasound, whether levobupivacaine or ropivacaine, can provide adequate and effective analgesia after PCNL.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials

Zhao¹,

Kan

Huang³

et al. 2022

Front. Surg.

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BackgroundParavertebral block (PVB) has been widely used in postoperative analgesia, especially in thoracic and breast surgery. However, the efficacy and safety of PVB for analgesia after renal surgery remains uncertain. Therefore, this study aimed to determine the postoperative analgesic efficacy and safety of PVB in renal surgery.MethodsPubMed, Web of Science, Embase, and the Cochrane Library databases were systematically searched up to December 20, 2021. All randomized controlled trials (RCTs) evaluating the postoperative analgesic efficacy of PVB in renal surgery were collected. The meta-analysis was performed using RevMan 5.4 and Stata/MP 14.0 software.ResultsA total of 16 RCTs involving 907 patients were included in the meta-analysis. Ten studies investigated patients under percutaneous nephrolithotomy (PCNL), and six studies were done for patients under other renal surgery (nephrectomy or pyeloplasty). Compared with control groups (no block, sham block, or other nerve blocks), meta-analysis showed that PVB reduced 24-hour postoperative opioid consumption significantly (SMD = −0.99, 95%CI: −1.60–0.38, p = 0.001, I2 = 92%) and reduced pain scores at various time points within 24 h at rest and 1 h, 4 h, and 24 h at movement after renal surgery, furthermore, PVB prolonged the time to first postoperative analgesic requirement (SMD = 2.16, 95%CI: 0.94–3.39, p = 0.005, I2 = 96%) and reduced the incidence of postoperative additional analgesia (OR = 0.14, 95%CI: 0.06∼0.33, p < 0.00001, I2 = 50%). Subgroup analysis revealed that the postoperative analgesia effect of PVB was more significant in PCNL, and the use of bupivacaine for PVB seemed to have a better performance. Besides, there was no difference in the incidence of postoperative nausea, vomiting, and itching between PVB and control groups.ConclusionThis study indicates that PVB may provide effective postoperative analgesia in patients under renal surgery, especially PCNL patients. Moreover, PVB is a safe analgesic method without significant analgesia-related complications.

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Section: Discussionmentioning

confidence: 99%