Postoperative analgesic efficacy of fluoroscopy-guided erector spinae plane block after percutaneous nephrolithotomy (PCNL): A randomized controlled study

Abstract

Background: Percutaneous nephrolithotomy (PCNL) a minimally invasive method for the removal of renal calculi and is associated with significant pain in postoperative period. Conventionally, intravenous opioids, local anesthetic infiltration, and regional blocks (intercostal/paravertebral blocks) have been tried with less efficacy to control postoperative pain. The present study is conducted to assess the effectiveness of erector spinae plane block (ESPB) performed under fluoroscopy guidance for postoperative analgesia during PCNL.

Subjects and methods: After obtaining ethical clearance, the study was conducted on 61 American Society of Anaesthesiologists (ASA) I and II patients aged between 18-65 years admitted for PCNL. Group I (n = 30) did not receive ESPB while Group II (n = 31) received ESPB under fluoroscopy guidance and 20 ml of 0.375% ropivacaine was administered after PCNL. Patient-reported pain intensity using visual analogue scale (VAS) was considered as a primary outcome. The hemodynamic variables (heart rate, systolic, diastolic, and mean blood pressure) was considered as a secondary outcome. Statistical analysis was performed using Student's t-test and Mann-Whitney U test. Data analysis was performed using the Statistical Package for the Social Sciences version 23.0.

Results: Postoperatively VAS score was significantly lower in Group II at 0, 1, 2, 3, 4, 6, 12, 18, and 24 hours after PCNL (P < 0.001). Dose of rescue analgesia significantly decreased in Group II compared to Group I.

Conclusion: ESPB performed under fluoroscopic guidance is a simple and effective technique and it provides significantly better postoperative pain relief.

Keywords: Erector spinae plane block; postoperative analgesia; ropivacaine.

Figure 1

Landmarks showing point of entry (POE)

Figure 2

(a) Epidural needle in situ at POE. (b) Needle is touching transverse process (T. P.) of eighth thoracic level (Fluoroscopic anterior–posterior view)

Figure 3

(a) Linear spread of contrast between erector spinae muscle and transverse process (Fluoroscopic anterior–posterior view). (b) Increasing spread of contrast after injection of drug (Fluoroscopic anterior– posterior view)

Figure 4

(a) Caudal and cephalic spread of contrast near transverse processes (Fluoroscopic lateral view). (b) Increasing spread of contrast after injection of drug (Fluoroscopic lateral view )

Figure 5

CONSORT 2010 Flow Diagram

Graph 1

Comparison of postoperative mean pulse rate in both groups

Graph 2

Comparison of systolic blood pressure, diastolic blood pressure and mean arterial pressure (mmHg) in both groups postoperatively