Effect of Intercostal Nerve Block and Nephrostomy Tract Infiltration With Ropivacaine on Postoperative Pain Control After Tubeless Percutaneous Nephrolithotomy: A Prospective, Randomized, and Case-controlled Trial

• Published in: Urology (Ridgewood, N.J.) Vol. 114; pp. 49 - 55
• Main Authors: Choi, Sae Woong, Cho, Shin Jay, Moon, Hyong Woo, Lee, Kyu Won, Lee, Sang Hoon, Hong, Sang Hyun, Choi, Yong Sun, Bae, Woong Jin, Ha, U-Syn, Hong, Sung-Hoo, Lee, Ji Youl, Kim, Sae Woong, Cho, Hyuk Jin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Adult; Aged; Analysis of Variance; Case-Control Studies; Chi-Square Distribution; Female; Humans; Intercostal Nerves - drug effects; Intraoperative Care - methods; Length of Stay; Male; Middle Aged; Nephrolithiasis - diagnostic imaging; Nephrolithiasis - surgery; Nephrolithotomy, Percutaneous - methods; Nephrostomy, Percutaneous - instrumentation; Nephrostomy, Percutaneous - methods; Nerve Block - methods; Pain Measurement; Pain, Postoperative - physiopathology; Pain, Postoperative - prevention & control; Patient Positioning - methods; Prognosis; Prospective Studies; Risk Assessment; Ropivacaine - administration & dosage; Severity of Illness Index; Treatment Outcome; Ultrasonography, Doppler - methods
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2017.12.004

To determine the efficacy of intercostal nerve block and nephrostomy tract infiltration (NTI) with ropivacaine in patients undergoing tubeless percutaneous nephrolithotomy (TPCNL). From February 2015 to March 2017, a total of 226 patients undergoing TPCNL were enrolled. After excluding 130 patients who failed to meet the inclusion criteria, a total of 96 eligible patients were randomized into 3 groups: group I, control group (n = 32); group II, intercostal nerve block with 15 mL of 0.5% ropivacaine and epinephrine (n = 32); and group III, NTI with 20 mL of 0.25% ropivacaine and epinephrine (n = 32). Pain status was assessed at postoperative 2, 8, and 24 hours and at discharge by visual analog scale score at rest (RVAS) and on deep breathing and coughing. Patient demographics and perioperative data between groups were comparable except for length of stay. Mean RVAS scores at postoperative 2 and 8 hours for group III were significantly less than those for group I (RVAS at 2 hours: 2.6 vs 4.9, P = .001; RVAS at 8 hours: 1.7 vs 3.3, P = .007). Mean RVAS scores at postoperative 24 hours had borderline significance (P = .050) among the 3 groups. Differences in mean deep breathing and coughing scores among groups were statistically significant (P = .002) only in the first 2 hours. All postoperative complications (5.4%, 5 per 92) were of grade 1 and not significantly different among groups. NTI is safe and effective in alleviating early postoperative pain for patients who underwent TPCNL.