Chen Tao, Zhu ZhenQiang, Du Jianlong
Department of Anesthesiology, Tongxiang First People's Hospital, Tongxiang, China.
Front Surg. 2021 Jan 28;8:623605. doi: 10.3389/fsurg.2021.623605. eCollection 2021.
We aimed to assess the efficacy of intercostal nerve block (ICNB) for pain relief after percutaneous nephrolithotomy (PCNL). 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. 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; I = 99%; = 0.77), 12 h (MD -0.98; 95% CI -4.90, 2.94; I = 99%; = 0.62) and 24 h (MD 0.16; 95% CI -0.90, 1.21; I = 88%; = 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; I = 47%; = 0.04), 12 h (SMD -2.49; 95% CI -4.84, -0.13; I = 96%; = 0.04) and 24 h (SMD -1.22; 95% CI -2.12, -0.32; I = 88%; = 0.008). The total analgesic requirement in morphine equivalents was not significantly different between the two groups. 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.
我们旨在评估肋间神经阻滞（ICNB）对经皮肾镜取石术（PCNL）后疼痛缓解的疗效。对PubMed、Science Direct、BioMed Central、CENTRAL、Embase和谷歌学术数据库进行了电子检索。纳入了所有针对接受PCNL的成年患者开展的研究，这些研究将ICNB与对照组或任何其他麻醉方法进行比较，并报告术后疼痛结果。共纳入6项研究。这些研究将ICNB与肾周（PT）浸润以及与对照组进行了比较。ICNB与PT浸润的汇总分析表明，两组在6 - 8小时（MD -0.44；95%CI -3.41，2.53；I² = 99%；P = 0.77）、12小时（MD -0.98；95%CI -4.90，2.94；I² = 99%；P = 0.62）和24小时（MD 0.16；95%CI -0.90，1.21；I² = 88%；P = 0.77）的疼痛评分上没有差异。两组首次需要镇痛的时间也没有显著差异。ICNB与对照组的荟萃分析表明，两组在8小时（MD -1.55；95%CI -2.60，-0.50；I² = 47%；P = 0.04）、12小时（SMD -2.49；95%CI -4.84，-0.13；I² = 96%；P = 0.04）和24小时（SMD -1.22；95%CI -2.12，-0.32；I² = 88%；P = 0.008）的疼痛评分上存在统计学显著差异。两组以吗啡当量计算的总镇痛需求量没有显著差异。ICNB可能对减轻PCNL术后疼痛有效。然而，其疗效可能并不优于PT浸润。目前的证据来自数量有限的研究。此外，需要高质量的随机对照试验来提供有力证据。
