Title: Efficacy of Peri-Operative Intercostal Nerve Blockade in Standard PCNL- A Prospective Cohort Study
Authors: Dr A T Rajeevan, Dr Shanmughadas K V, Dr Piyush Gupta, Dr Felix Cardoza
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.06
Abstract
Introduction and Aim: Percutaneous nephrolithotomy (PCNL) has become the GOLD standard for the management of renal calculi. But pain in the immediate post-op period especiallyin institutions where Standard PCNL is still being done as a routine, can be quite severe, requiring opioid administration. Intercostal Nerve Blockade (INB) is an effective way to optimize pain control and to reduce the need for opioid administration in the post-operative period in such patients. We aimed to evaluate the role of INB in Standard PCNL in terms of post-operative analgesia requirement, speed of mobilization and total duration of inpatient stay.
Methods: 60 patients undergoing elective standard PCNL were divided into Study group or Group S (0.25% bupivacaine infiltration) and Control group or Group C (without infiltration). Percutaneous INB was done in the study group at the end of the procedure prior to the patient being turned supine. The three intercostal nerves supplying the dermatomes within which the incisions were made were blocked. At each site, 5 ml of 0.25% bupivacaine in group S was infiltrated. Postoperative pain was assessed by visual analogue scale (VAS) at rest {score between 0 and 10} and dynamic visual analogue scale (DVAS) during deep breathing and coughing {score between 0 and 10} every 4 hours for first 24 hours. Intravenous tramadol was given as rescue analgesia when VAS score was >4. Time to first rescue analgesic and total amount of tramadol required in first 24 hours were noted.
Results: VAS and DVAS scores in Group S were significantly lower (p <0.05) than Group C till first 16 hours. Mean time to first rescue analgesia in Group S was significantly longer (9.07 hrs. v/s 1.50 hrs.). And total consumption of tramadol in first 24 hours was also significantly less in Group S compared to Group C (58.06mg v/s 132.76mg).
Conclusion: Intercostal nerve block is an easy, safe and inexpensive method of analgesia and provides effective postoperative analgesia after standard PCNL.
Keywords: PCNL, Intercostal Nerve Blockade, Post-operative pain scores.
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