Efficiency and Safety of Erector Spinae Plane Block in Percutaneous Nephrolithotomy: A Meta-Analysis Based on Randomized Controlled Trials

Ma, Yucheng; Lin, Lede; Xiao, Kan; Luo, Zhumei; Jin, Tao

doi:10.1016/j.urology.2022.07.017

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…It was reported that EPSB could provide better short-term (1-2 h) and long-term (24 h) pain control in PCNL patients. 16 In our study, the median time to first press of PCA was 2.9 h for ESPB with ropivacaine, which was in line with previous researches. 16 While the time to first press of PCA was prolonged in the other two groups in which different doses of nalbuphine were used.…”

Section: Discussionsupporting

confidence: 92%

“…16 In our study, the median time to first press of PCA was 2.9 h for ESPB with ropivacaine, which was in line with previous researches. 16 While the time to first press of PCA was prolonged in the other two groups in which different doses of nalbuphine were used. There was no significant difference in long-term (24 h) VAS scores between the three groups.…”

Section: Discussionsupporting

confidence: 92%

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Analgesic Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Erector Spinae Plane Block for Percutaneous Nephrolithotomy: A Randomized, Double-Blinded, Clinical Trial

Sun,

Wu,

Wang

et al. 2023

DDDT

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Background: Erector spinae plane block (ESPB) is an easy and safe method for postoperative analgesia. However its effect lasts only for several hours. This trial was to investigate the effectiveness of different doses of nalbuphine as an adjuvant to ropivacaine in ESPB for patients undergoing percutaneous nephrolithotomy (PCNL). Methods: Patients scheduled for PCNL were randomized into three groups and received ultrasound-guided ESPB at T 10 level for postoperative analgesia. Each subject received 28 mL of 100 mg ropivacaine solution mixed with 2 mL of normal saline (Group R), 2 mL of 10 mg nalbuphine (Group RNL), or 2 mL of 20 mg nalbuphine (Group RNH). Primary outcome was the time to first opioid demand. Secondary outcomes were morphine consumption, VAS scores within 24 h postoperatively, rescue analgesic requirements, and length of hospital stay. Results:The median [interquartile range, IQR] time to first opioid demand was significantly longer in group RNH (8.70 [6.90,14.85] h) than that of group R and group RNL (2.90 [2.00,6.30] h and 5.80 [2.95,7.00] h, respectively). VAS scores (either resting or active) within 24 h postoperatively were comparable between the three groups, with the most significant differences especially at 4, 6, 8 h. Morphine consumption at 24 h postoperatively was significant for R group vs RNH group (median difference, 9; 95% confidence interval [CI], 1.57 to 16.43; p = 0.02). Conclusions: Adding 20mg nalbuphine to ropivacaine in ESPB could significantly improve the effect of analgesia and prolong the duration of nerve blocks for PCNL.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Analgesic Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Erector Spinae Plane Block for Percutaneous Nephrolithotomy: A Randomized, Double-Blinded, Clinical Trial

Sun,

Wu,

Wang

et al. 2023

DDDT

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“…However, the nephrostomy tube is the main cause of discomfort and pain for patients. There are several methods available to reduce post-PCNL pain, including preoperative subarachnoid anesthesia with a lumbar block [33], intraoperative use of various analgesics, reduction of the size or removal of the nephrostomy tube, postoperative local anesthetic in ltration around the nephrostomy tube, thoracic paravertebral block (T11-L1) [34,35], and intercostal nerve block [36]. Wang et al [37] suggested that patients with local in ltration anesthesia via the perinephric nephrostomy tube had less analgesic requirements, longer time to rst analgesic requirement, and lower VAS scores at 24 hours postoperatively than those without in ltration.…”

Section: Discussionmentioning

confidence: 99%

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Wei

et al. 2022

Preprint

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Objectives: This study aimed to develop severe pain prediction models for patients after percutaneous nephrolithotomy (PCNL), to identify and intervene the risk factors causing pain in a timely manner so as to improve patient satisfaction after surgery. Methods: The clinical data of 331 PCNL patients were retrospectively analyzed. Data of 265 patients (80%) were randomly selected as the training cohort and those of 66 (20%) patients were selected as the validation cohort. We choosed clinical data through the stepwise Akaike information criterion and best subset selection to build severe pain prediction models by the training data set. The validity of the model was verified and analyzed using the test data set. Results: The first clinical model was developed using the American Society of Anesthesiologists (ASA) classification, number of kidney stones, history of hydronephrosis, duration of surgery, and presence of stone remnants after surgery. This model had an area under the curve (AUC) of 0.8682 (95% confidence interval [CI], 0.8205–0.9160), threshold of 0.4771, sensitivity of 97.25%, specificity of 63.86%, and negative predictive value (NPV) of 91.38%. The second model was developed using the mentioned above six clinical features and size of kidney stones. This model showed a stronger discriminatory power (P=0.208), with an AUC of 0.8710 (95% CI, 0.8242–0.9187), threshold of 0.4813, sensitivity of 97.25%, specificity of 83.86%, and NPV of 91.38%. In the subsequent validation cohort (N = 66), the AUC (95% CI) was 0.9093 (0.8378–0.9808) for the first clinical model and 0.9098 (0.8373–0.9823) for the second clinical models. Conclusion: We developed two prediction models for postoperative pain severity in PCNL patients, which were validated internally. Trial registration: This is a retrospective study that does not include sensitive patient data, but only data provided by professionals from selected centres about their daily clinical practice. Therefore, our ethics Committee did not consider it necessary to register the study.

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“…A meta-analysis of quadratus lumborum block evaluated nine randomized clinical trials and found that the block was associated with significantly lower opioids consumption and less pain after surgery [25 ▪ ]. A meta-analysis of erector spinae plane blocks looked at six studies and concluded that the block led to less intraoperative fentanyl use, less total tramadol or paracetamol postoperative consumption and longer time to rescue analgesia use [26].…”

Section: Postoperative Painmentioning

confidence: 99%

“…Li ]. A metaanalysis of erector spinae plane blocks looked at six studies and concluded that the block led to less intraoperative fentanyl use, less total tramadol or paracetamol postoperative consumption and longer time to rescue analgesia use [26].…”

Section: Andandmentioning

confidence: 99%

Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy

Stern¹

2023

Current Opinion in Urology

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Purpose of reviewPercutaneous nephrolithotomy (PCNL) continues as the gold standard for the surgical management of large renal stones. This short review is intended to highlight recent publications on PCNL of all tract sizes, from mini to standard. Recent findingsLiterature on PCNL in the last 2 years has focused on several main themes --decreasing complications, improving postoperative pain control, and new technology to improve outcomes. Mini-PCNL continues to prove effective and safe, with a new vacuum sheath showing promise of improving stone-free rates and decreasing infections. In terms of infections, preoperative midstream urine culture continues to be a poor indicator of postoperative infection. One of the biggest changes to PCNL practice is the reintroduction of tranexamic acid, which has shown to significantly decrease bleeding and improve outcomes. In terms of postoperative pain control, local blocks are effective and low risk.

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Efficiency and Safety of Erector Spinae Plane Block in Percutaneous Nephrolithotomy: A Meta-Analysis Based on Randomized Controlled Trials

Cited by 5 publications

References 25 publications

Analgesic Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Erector Spinae Plane Block for Percutaneous Nephrolithotomy: A Randomized, Double-Blinded, Clinical Trial

Analgesic Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Erector Spinae Plane Block for Percutaneous Nephrolithotomy: A Randomized, Double-Blinded, Clinical Trial

Clinical Prediction Model for Severe Pain After Percutaneous Nephrolithotomy and Analysis of Associated Factors ：A Retrospective Study

Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy

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