Perioperative intercostal nerve blockade in percutaneous nephrolithotomy—A comparative cohort study

Introduction and objective: Intercostal nerve blockade is well established in thoracic surgery but since the technique was first described in relation to percutaneous nephrolithotomy (PCNL) in 1990, there has been no evaluation of the impact of this technique on post-operative recovery of PCNL patients. We set out to prove the null hypothesis that intercostal nerve blockade offers no analgesic advantage to the patient undergoing PCNL. Methods: Retrospectively analyzing a prospectively collected dataset, we compared 50 consecutive patients undergoing PCNL with a further 50 consecutive patients undergoing PCNL and provided with the same anaesthetic but with the addition of an intercostal nerve block using local anaesthetic at the end of the operation, prior to the patient waking. The surgery was performed by a single surgeon in a single institution but different anaesthetists were involved accounting for the variation in post-operative analgesic management. The dataset includes pain scores using a visual analogue scale and analgesic requirements using a patient controlled morphine syringe driver (PCA). These data, along with data concerning time to mobilization and hospital stay were interpreted using bivariate tabular analysis methods. Results: The use of intercostal nerve blockade significantly (P < 0.05) decreased the amount of analgesia required by the patient. The use of intercostal nerve blockade also significantly (P < 0.05) increased the speed of mobilization and decreased inpatient stay. Conclusions: We reject the null hypothesis. The use of post-operative intercostal nerve blockade does offer an analgesic advantage for patients undergoing PCNL. Given our results we would recommend further prospective evaluation of the technique.