Peripheral nerve block analgesia after percutaneous nephrolithotomy: a systematic review and network meta-analysis.

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is a common surgical procedure for the removal of kidney stones. Adequate postoperative analgesia is crucial for enhancing recovery and minimizing complications. Peripheral nerve blocks (PNBs) have emerged as a promising method for managing postoperative pain in PCNL patients. This systematic review and network meta-analysis (NMA) aim to evaluate the efficacy of various PNBs for analgesia after PCNL.

Evidence acquisition: A comprehensive literature search was conducted in electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library up to April 2025. Randomized controlled trials (RCTs) that compared different PNBs or PNBs with no block after PCNL were included. The primary outcome was the total morphine consumption within the first 24 hours postoperatively. The NMA was performed using Stata 15.1 software.

Evidence synthesis: We included 38 RCTs involving 2,339 patients and assessed seven analgesic techniques. The total morphine consumption was most significantly reduced by intercostal nerve block (ICNB), followed by peritubal infiltration (PI) and erector spinae plane block (ESPB). At 6 hours postoperatively, the resting Visual Analog Scale (VAS) scores were lower with ICNB, followed by PI and ESPB. At 12 hours, resting VAS scores decreased with paravertebral block (PVB), followed by ICNB and PI. At 24 hours, resting VAS scores were reduced by PVB, then epidural block (EB), and ICNB. For dynamic-induced pain at 6 hours, VAS scores were decreased by quadratus lumborum block (QLB), followed by ICNB and PI. At 12 hours, dynamic VAS scores were lower with ESPB, followed by ICNB and PI. At 24 hours, dynamic VAS scores decreased with PVB, followed by EB and ICNB. Postoperative nausea and vomiting (PONV) were reduced by ICNB, followed by PI and PVB. The time to first rescue analgesia was prolonged with ICNB, followed by QLB and PI. The number of patients requiring additional analgesics were decreased with ICNB, followed by PI and QLB.

Conclusions: The NMA indicated that ICNB was likely the optimal technique for postoperative analgesia in patients undergoing PCNL. In contrast, the TAPB appears to be less effective.