Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 11 (4), 363-368

Efficacy of Intercostal Nerve Block With 0.25% Bupivacaine in Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Trial


Efficacy of Intercostal Nerve Block With 0.25% Bupivacaine in Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Trial

Iqbal Singh et al. Urol Ann.


Introduction and aim: Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared.

Materials and methods: After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717.

Results: Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien-Dindo classification) which were not statistically significant.

Conclusion: Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.

Keywords: Bupivacaine; intercostal block; percutaneous nephrolithotomy; peritubal block.

Conflict of interest statement

There are no conflicts of interest.


Figure 1
Figure 1
Study flowchart

Similar articles

See all similar articles


    1. Cormio L, Preminger G, Saussine C, Buchholz NP, Zhang X, Walfridsson H, et al. Nephrostomy in percutaneous nephrolithotomy (PCNL): Does nephrostomy tube size matter? Results from the global PCNL study from the Clinical Research Office Endourology Society. World J Urol. 2013;31:1563–8. - PubMed
    1. Parikh GP, Shah VR, Modi MP, Chauhan NC. The analgesic efficacy of peritubal infiltration of 0.25% bupivacaine in percutaneous nephrolithotomy – A prospective randomized study. J Anaesthesiol Clin Pharmacol. 2011;27:481–4. - PMC - PubMed
    1. Kıraç M, Tepeler A, Bozkurt OF, Elbir F, Ozluk C, Armagan A, et al. The efficacy of bupivacaine infiltration on the nephrostomy tract in tubeless and standard PCNL: A prospective, randomized, multicenter study. Urology. 2013;82:526–531. - PubMed
    1. Singh I, Kumar A, Kumar P. “Ambulatory PCNL” (tubeless PCNL under regional anesthesia) – A preliminary report of 10 cases. Int Urol Nephrol. 2005;37:35–7. - PubMed
    1. Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: Is it really less morbid? J Endourol. 2008;22:427–34. - PubMed