A Randomized Control Trial Evaluating Efficacy of Nephrostomy Tract Infiltration with Bupivacaine After Tubeless Percutaneous Nephrolithotomy

Shah, Hemendra N.; Shah, Rashmi; Sodha, Hiren S.; Khandkar, Amit A.; Gokhale, Aniruddha

doi:10.1089/end.2011.0465

Cited by 11 publications

(4 citation statements)

References 13 publications

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“…Grimsby et al 19 evaluated the effect of continuous intravenous ketorolac versus placebo in patients undergoing renal surgery, including laparoscopic donor nephrectomy and PCNL; in their study, ketorolac did not reduce the pain scores postoperatively. However, other interventions, such as administration of intravenous paracetamol, 20 infiltration of the nephrostomy tract with bupivicaine, 21 and intercostal nerve block, 22 have all demonstrated a reduction in perioperative analgesic use after PCNL.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Use and Complications Following Upper Pole Access for Percutaneous Nephrolithotomy

Lightfoot

Engebretsen

et al. 2014

Journal of Endourology

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Patients undergoing PCNL through UPA had a higher ultimate stone-free rate compared with LPA, while postoperative analgesic requirements and overall complication rates were similar between access sites. A trend toward higher thoracic complication rates was observed in the UPA group, although this did not reach statistical significance. Surgeons should not hesitate to utilize UPA when indicated for patients with large or complex stones.

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Section: Discussionmentioning

confidence: 99%

Analgesic Use and Complications Following Upper Pole Access for Percutaneous Nephrolithotomy

Lightfoot

Engebretsen

et al. 2014

Journal of Endourology

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“…Subcutaneous infiltration of the surgical site with a local anesthetic is a common practice in several surgical specialties, however, its role in PCNL is questionable (28). However, PT infiltration along the entire length of the nephrostomy tract has shown benefits for post-operative analgesia (29,30). In our analysis comparing ICNB with PT infiltration, we did not find any statistically significant differences between the two techniques for pain scores or time for first analgesic demand.…”

Section: Discussionmentioning

confidence: 53%

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

Chen

Zhu

2021

Front. Surg.

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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.

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“…[3] showed that the TAR was statistically lower in bupivacaine group (156.7 mg vs. 209.8 mg), suggesting that PT bupivacaine was effective in alleviating postoperative pain, which was also supported by Shah et al . [15] Parikh et al . [2] showed a lower TAR in the bupivacaine (0.25%) versus control/saline group (119.3 mg and 276.8 mg, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…Shah et al . [15] demonstrated that the VAS score at various time intervals was lower in the bupivacaine infiltration group after the tubeless PCNL. The difference between the two groups (bupivacaine vs. control) was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

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

Yadav

Gupta

2019

Urol Ann

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Introduction and Aim:Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared.Materials and Methods:After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717.Results:Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien–Dindo classification) which were not statistically significant.Conclusion:Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.

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A Randomized Control Trial Evaluating Efficacy of Nephrostomy Tract Infiltration with Bupivacaine After Tubeless Percutaneous Nephrolithotomy

Abstract: Nephrostomy tract infiltration of bupivacaine in tubeless PCNL is associated with less postoperative pain and analgesia requirement.

Cited by 11 publications

References 13 publications

Analgesic Use and Complications Following Upper Pole Access for Percutaneous Nephrolithotomy

Analgesic Use and Complications Following Upper Pole Access for Percutaneous Nephrolithotomy

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

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

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