Effect of Intercostal Nerve Block and Nephrostomy Tract Infiltration With Ropivacaine on Postoperative Pain Control After Tubeless Percutaneous Nephrolithotomy: A Prospective, Randomized, and Case-controlled Trial

Objective To determine the efficacy of intercostal nerve block and nephrostomy tract infiltration (NTI) with ropivacaine in patients undergoing tubeless percutaneous nephrolithotomy (TPCNL). Materials and Methods From February 2015 to March 2017, a total of 226 patients undergoing TPCNL were enrolled. After excluding 130 patients who failed to meet the inclusion criteria, a total of 96 eligible patients were randomized into 3 groups: group I, control group (n = 32); group II, intercostal nerve block with 15 mL of 0.5% ropivacaine and epinephrine (n = 32); and group III, NTI with 20 mL of 0.25% ropivacaine and epinephrine (n = 32). Pain status was assessed at postoperative 2, 8, and 24 hours and at discharge by visual analog scale score at rest (RVAS) and on deep breathing and coughing. Results Patient demographics and perioperative data between groups were comparable except for length of stay. Mean RVAS scores at postoperative 2 and 8 hours for group III were significantly less than those for group I (RVAS at 2 hours: 2.6 vs 4.9, P = .001; RVAS at 8 hours: 1.7 vs 3.3, P = .007). Mean RVAS scores at postoperative 24 hours had borderline significance (P = .050) among the 3 groups. Differences in mean deep breathing and coughing scores among groups were statistically significant (P = .002) only in the first 2 hours. All postoperative complications (5.4%, 5 per 92) were of grade 1 and not significantly different among groups. Conclusion NTI is safe and effective in alleviating early postoperative pain for patients who underwent TPCNL.