Efficacy of bupivacaine infiltration on pain control in standard percutaneous nephrolithotomy: a meta-analysis of randomized controlled trials

Introduction: The efficacy of bupivacaine infiltration to control pain for standard percutaneous nephrolithotomy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of bupivacaine infiltration on pain control for standard percutaneous nephrolithotomy. Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through January 2018 for randomized controlled trials (RCTs) assessing the effect of bupivacaine infiltration on pain control in standard percutaneous nephrolithotomy. Meta-analysis is performed using the random-effect model. Results: Six RCTs involving 337 patients are included in the meta-analysis. Overall, compared with control group for standard percutaneous nephrolithotomy, bupivacaine infiltration can significantly reduce VAS at postoperative 12 h (Std. MD=-0.87; 95% CI=-1.27 to -0.48; P < 0.0001) and 24 h (Std. MD=-0.78; 95% CI=-1.24 to -0.32; P=0.0008), as well as prolong the time of first an= algesic demand (Std. MD=1.02; 95% CI=0.43 to 1.62; P=0.0008), but has no remarkable influence on VAS at postoperative 6 h (Std. MD=-0.33; 95% CI=-0.81 to 0.15; P=0.18), doses of analgesic usage (Std. MD=-0.50; 95% CI=-1.24 to 0.24; P=0.18), operative time (Std. MD=0.13; 95% CI=-0.14 to 0.40; P=0.33), hospital stay (Std. MD=0.07; 95% CI=-0.30 to 0.45; P=0.70), nausea/vomiting (RR=0.52; 95% CI=0.27 to 1.00; P=0.05). Conclusions: Bupivacaine infiltration has important ability to alleviate the pain and prolong the time of first analgesic demand for standard percutaneous nephrolithotomy.