Paravertebral block reduced opioid intake after percutaneous nephrolithotomy

A new study published in Frontiers in Surgery shows that Paravertebral block (PVB) can effectively reduce postoperative pain in kidney surgery patients, especially percutaneous nephrolithotomy (PCNL) patients.

Vertebral blocks have been widely used in postoperative pain relief, especially in thoracic surgery. However, the efficacy and safety of PVB for pain relief after renal surgery remains uncertain. Therefore, You Zhao and his team performed this study to determine the post-operative analgesia and safety of PVB in renal surgery.

All randomized controlled trials (RCTs) until December 20, 2021 which evaluated the postoperative analgesia of PVB in renal surgery were included. A total of 16 RCTs involving 907 patients were included in the meta-analysis. 

The main findings of this study are:

1. Ten studies involved patients undergoing PCNL and six involving patients undergoing other kidney surgery (nephrectomy or pyeloplasty).

2. Compared with the control group (pseudo-blocks, no blocks, or other nerve blocks), the meta-analysis showed that PVB significantly reduced postoperative opioid consumption at 24 h and decreased pain scores at other time points.

3. Within 24 h of rest and 1 h, 4 h, and 24 h of exercise after renal surgery, in addition, PVB prolongs the time to first postoperative analgesia and reduces the rate of additional postoperative analgesia art.

4. Subgroup analysis showed that the postoperative analgesia effect of PVB was greater in PCNL, and the use of bupivacaine for PVB appeared to have better efficacy.

5. In addition, there was no difference in the incidence of postoperative nausea, vomiting and pruritus between the PVB group and the control group.

In conclusion, this study indicates that PVB can effectively provide postoperative analgesia in renal surgery patients, especially in PCNL. In addition, PVB is a safe pain reliever method that does not cause dangerous complications. Limited by the quality of the included studies, the above findings still need to be verified by higher quality RCTs.

Reference: 

Zhao, Y., Kan, Y., Huang, X., Wu, M., Luo, W., & Nie, J. (2022). The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials. In Frontiers in Surgery (Vol. 9). Frontiers Media SA. https://doi.org/10.3389/fsurg.2022.865362