title: A randomized, double-blinded, placebo-controlled trial of intercostal nerve block after percutaneous nephrolithotomy.
abstract: OBJECTIVE
  The optimal method of pain control after percutaneous nephrolithotomy (PCNL) remains controversial. We sought to determine whether intercostal nerve block with bupivicaine provided superior pain control, when compared with placebo, with a lower need for narcotics and improved health-related quality of life (HRQL) in the immediate postoperative period.
  
  
  METHODS
  Sixty-three patients were randomized to receive intercostal blockade with either 20 mL of 0.5% bupivacaine with epinephrine or 20 mL physiologic saline. All patients received intravenous narcotic patient-controlled analgesia (PCA) postoperatively. Data were collected on stone parameters, demographics, analgesic usage, length of stay, and HRQL as assessed by the Postoperative Recovery Scale.
  
  
  RESULTS
  The mean age was 47.7±1.2 years; mean body mass index was 28.0±5.0 kg/m(2); mean stone diameter was 29.2±15.8 mm. Within the first 3 to 6 hours after surgery, there was a significant reduction in narcotic use for the group receiving intercostal nerve blockade with bupivacaine compared with placebo. At 3 hours, narcotic use was 2.4±3.1 mg vs 4.3±3.8 mg morphine equivalents (P=0.034), and within 6 hours of surgery, narcotic use was 5.9±6.1 mg vs 8.8±7.4 mg (P=0.096). Durable improvement in HRQL was also observed in patients receiving intercostal nerve blockade with bupivacaine compared with placebo (P=0.034). No complications were attributable to the intercostal nerve blocks in either group.
  
  
  CONCLUSIONS
  Intercostal blockade with bupivacaine significantly improves both pain control and HRQL in the early postoperative period. The effectiveness of bupivacaine disappears within 6 hours of surgery, after which narcotic use becomes indistinguishable. Intercostal nerve blockade is an easy, safe, and inexpensive method that can be used to optimize pain control after PCNL.
authors: Division of Urology, St. Michael's Hospital, Toronto, Ontario, Canada. honeyj@smh.toronto.on.ca
authors: R John D'A
authors: RJ
authors: Honey
authors: Daniela
authors: D
authors: Ghiculete
authors: A Andrew
authors: AA
authors: Ray
authors: Kenneth T
authors: KT
authors: Pace
mesh_terms: D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010919:Placebos; D011182:Postoperative Care; D011788:Quality of Life
chemical_list: D009294:Narcotics; D010919:Placebos