Analgesic efficacy of erector spinae plane block in percutaneous nephrolithotomy : A randomized controlled trial

Abstract

Background: The postoperative pain in percutaneous nephrolithotomy (PCNL) is due to dilatation of the renal capsule and the parenchymal tract. The aim of the study was to evaluate the analgesic effect of preoperative single-shot ultrasound(US)-guided erector spinae plane block (ESPB) at theT11 vertebral level in patients undergoing PCNL.

Material and methods: In this prospective randomized controlled study 56 patients were randomized into 2 groups; group B and group C. An erector spinae plane block (ESPB) was performed preoperatively in all patients; patients in group B received 30 ml 0.25% bupivacaine, while patients in group C received 30 ml normal saline as placebo. The following parameters were evaluated: intraoperative fentanyl consumption, time to first use of patient controlled analgesia (PCA), postoperative morphine consumption over 24 h, pain scores at 0, 2, 4, 6, 12 and 24 h, sedation scores at 2, 6, 12 and 24 h, and patient satisfaction.

Results: Patients in group B had lower intraoperative fentanyl consumption (P = 0.01), longer time to first use of PCA (P = 0.01), lower rescue morphine consumption over 24 h (P = 0.002), and higher patient satisfaction scores (P = 0.02). Postoperative numerical rating scale scores were lower in group B at 2 and 12 h (median = 3 and 2, respectively), as opposed to the control group (median = 4 and 3, respectively, P = 0.02). Sedation scores were higher in group C at 2 and 6 h after the procedure (P = 0.02 and 0.03, respectively).

Conclusion: The use of US-guided ESPB provides a good postoperative analgesia and decreases opioid consumption over 24 h in patients undergoing PCNL.

Keywords: Analgesic efficacy; Analgesics requirement; Morphine consumption; Pain relief; Postoperative.