Analgesic efficacy of intercostal nerve block in percutaneous nephrolithotomy: systematic review and meta-analysis

Introduction: Pain is important morbidity following percutaneous nephrolithotomy (PNL). Various adjunctive procedures such as intercostals nerve block (ICNB) have been described to reduce post-operative pain. The aim of this review was to determine the analgesic efficacy of ICNB in PNL patients. Materials and Methods: Systematic literature search was conducted to identify relevant publications. We followed preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines while conducting this review. Results: In this review, five randomized studies with 319 patients were included. The analgesic requirement was statistically similar in ICNB and control group (Standard mean difference (SMD) -0.48 confidence interval (CI)[-1.4, 0.44] p=0.31) whereas analgesic requirement was lower for peritubal infiltration group (PTI) as compared to ICNB (SMD 0.85 CI[0.25,1.44] p=0.005). Also, time to first analgesic requirement was similar between ICNB and PTI (SMD 0.86 CI[-9.3,11.0]), p=0.87). Pain according to VAS (visual analog scale) and Dynamic VAS (DVAS) at 24 hours was lower in ICNB group as compared to the control group; however, only DVAS at 24 hours was statistically significant. DVAS and VAS at 24 hours were similar for both ICNB and PTI. Conclusions: Intercostal nerve block in terms of analgesic requirement appears to be inferior to peritubal block and no better than control group. Also, mean pain scores for ICNB were similar to control group and peritubal block. Keywords: Percutaneous nephrolithotomy, Intercostal nerve block, Peritubal block, PNL, PCNL.