TY - JOUR
T1 - Opioid-Sparing Analgesic Effects of Peripheral Nerve Blocks in Percutaneous Nephrolithotomy
T2 - A Systematic Review
AU - Winoker, Jared S.
AU - Koo, Kevin
AU - Alam, Ridwan
AU - Matlaga, Brian R.
N1 - Publisher Copyright:
© Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Introduction: Multimodal analgesic regimens incorporating peripheral nerve blocks (PNBs) have demonstrated reduced postoperative pain, opioid use, and recovery time in various disease states. However, this remains a subject of limited investigation in the percutaneous nephrolithotomy (PCNL) domain. In the face of an ongoing opioid epidemic and collective push to enhance prescribing stewardship, we sought to examine the potential opioid-sparing effect of PNBs in PCNL. Methods: A systematic review of Embase and PubMed was performed to identify all randomized controlled trials evaluating the use of a PNB with general anesthesia (GA) vs GA alone for pain control following PCNL. Studies evaluating neuraxial (epidural and spinal) anesthesia and those without GA as the control arm were excluded. Results: Seventeen trials evaluating 1,012 procedures were included. Five different blocks were identified and evaluated: paravertebral (n = 8), intercostal nerve (n = 3), quadratus lumborum (n = 2), transversus abdominis plane (n = 1), and erector spinae (n = 3). Nine of 16 (56%) studies observed lower pain scores with PNB use throughout the 24-hour postop period. By comparison, improved pain scores with PNBs were limited to the early (<6 hours) recovery period in five studies and two found no difference. Total analgesic and opioid requirements were significantly higher in the GA control arm in nearly all studies (12/14, 86%). Operative times were similar and there were no differences in rates of intercostal access or nephrostomy tube insertion between study arms in any trial. Conclusions: While greater analgesic use with GA alone likely minimizes or obscures differences in patient-reported pain scores, PNBs may offer a significant opioid-sparing analgesic effect during postoperative recovery after PCNL.
AB - Introduction: Multimodal analgesic regimens incorporating peripheral nerve blocks (PNBs) have demonstrated reduced postoperative pain, opioid use, and recovery time in various disease states. However, this remains a subject of limited investigation in the percutaneous nephrolithotomy (PCNL) domain. In the face of an ongoing opioid epidemic and collective push to enhance prescribing stewardship, we sought to examine the potential opioid-sparing effect of PNBs in PCNL. Methods: A systematic review of Embase and PubMed was performed to identify all randomized controlled trials evaluating the use of a PNB with general anesthesia (GA) vs GA alone for pain control following PCNL. Studies evaluating neuraxial (epidural and spinal) anesthesia and those without GA as the control arm were excluded. Results: Seventeen trials evaluating 1,012 procedures were included. Five different blocks were identified and evaluated: paravertebral (n = 8), intercostal nerve (n = 3), quadratus lumborum (n = 2), transversus abdominis plane (n = 1), and erector spinae (n = 3). Nine of 16 (56%) studies observed lower pain scores with PNB use throughout the 24-hour postop period. By comparison, improved pain scores with PNBs were limited to the early (<6 hours) recovery period in five studies and two found no difference. Total analgesic and opioid requirements were significantly higher in the GA control arm in nearly all studies (12/14, 86%). Operative times were similar and there were no differences in rates of intercostal access or nephrostomy tube insertion between study arms in any trial. Conclusions: While greater analgesic use with GA alone likely minimizes or obscures differences in patient-reported pain scores, PNBs may offer a significant opioid-sparing analgesic effect during postoperative recovery after PCNL.
KW - PCNL
KW - opioids
KW - pain
KW - percutaneous nephrolithotomy
KW - peripheral nerve block
KW - regional anesthesia
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U2 - 10.1089/end.2021.0402
DO - 10.1089/end.2021.0402
M3 - Review article
C2 - 34314232
AN - SCOPUS:85123116447
SN - 0892-7790
VL - 36
SP - 38
EP - 46
JO - Journal of Endourology
JF - Journal of Endourology
IS - 1
ER -