Gyawali Sushil, Luitel Bhoj Raj, Bhattarai Amit Sharma, Sharma Uttam Kumar
Department of General Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Department of Urology and Kidney Transplant Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Indian J Urol. 2024 Jan-Mar;40(1):37-43. doi: 10.4103/iju.iju_276_23. Epub 2023 Dec 29.
Postoperative pain following percutaneous nephrolithotomy (PCNL) adds to the morbidity of patients requiring additional analgesia. Various modalities of pain control techniques, such as intercostal nerve block (ICNB) and peritract infiltration (PTI), are being studied for better pain management. This study compares the efficacy of ICNB with PTI for postoperative pain management.
A double-blinded, prospective, randomized control study was conducted, in which 0.25% bupivacaine, either ICNB or PTI, was given at the puncture site at the end of PCNL. The primary outcome was a comparison of postoperative pain score measured with resting Visual analogue Scale (r-VAS) and dynamic VAS (D-VAS) recorded at 2 h, 4 h, 8 h, 10 h, 12 h, 24 h, and at discharge. Injection ketorolac was given as rescue analgesia. Secondary outcomes include time to first rescue analgesia and total analgesic requirement (TAR).
Sixty patients were randomized into two equal groups with 63.3% male and 36.6% female, with a mean age of 37.25 ± 13.09 years. In Group ICNB, 24 (40%) and 6 (10%) patients and in Group PTI, 21 (35%) and 9 (15%) patients underwent standard and mini PCNL, respectively, in each group. All cases were PCNL doen in prone position. The mean R-VAS and D-VAS scores at 2, 4, 8, 12, 24, and 48 h were similar in both groups. The mean TAR was 56.84 ± 0.33.00 mg and 55.54 ± 0.29.64 mg of injection ketorolac in Group ICNB and PTI, respectively ( < 0.894). The time to first rescue analgesic demand were 7.11 ± 4.898 h and 6.25 ± 3.354 h ( < 0.527). Both the groups were comparable in terms of length of hospital stay, stone clearance rate, and complication rate.
The ICNB was as efficacious as PTI for postoperative pain control with 0.25% bupivacaine following PCNL.
经皮肾镜取石术（PCNL）后的术后疼痛增加了需要额外镇痛的患者的发病率。为了更好地进行疼痛管理，正在研究各种疼痛控制技术，如肋间神经阻滞（ICNB）和经皮肾穿刺通道周围浸润（PTI）。本研究比较了ICNB和PTI在术后疼痛管理中的疗效。
进行了一项双盲、前瞻性、随机对照研究，在PCNL结束时，在穿刺部位给予0.25%布比卡因，采用ICNB或PTI。主要结局是比较术后用静息视觉模拟评分法（r-VAS）和动态VAS（D-VAS）在2小时、4小时、8小时、10小时、12小时、24小时及出院时记录的疼痛评分。给予酮咯酸注射液作为补救镇痛。次要结局包括首次补救镇痛的时间和总镇痛需求量（TAR）。
60例患者被随机分为两组，每组30例，男性占63.3%，女性占36.6%，平均年龄为37.25±13.09岁。在ICNB组，分别有24例（40%）和6例（10%）患者，在PTI组，分别有21例（35%）和9例（15%）患者在每组中接受了标准PCNL和迷你PCNL。所有病例均在俯卧位下行PCNL。两组在2、4、8、12、24和48小时的平均r-VAS和D-VAS评分相似。ICNB组和PTI组的平均TAR分别为56.84±33.00mg和55.54±29.64mg的酮咯酸注射液（P<0.894）。首次补救镇痛需求的时间分别为7.11±4.898小时和6.25±3.354小时（P<0.527）。两组在住院时间、结石清除率和并发症发生率方面具有可比性。
PCNL术后，0.25%布比卡因的ICNB在术后疼痛控制方面与PTI同样有效。
