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. 2021 May;65(5):398-403.
doi: 10.4103/ija.IJA_1450_20. Epub 2021 May 20.

Comparison of erector spinae plane block and local anaesthetic infiltration of the incision site for postoperative analgesia in percutaneous nephrolithotomy - A randomised parallel-group study

Srinivasan Ramachandran  1 , Krishna P Ramaraj  1 , Savitri Velayudhan  2 , Balasubramanian Shanmugam  1 , Sureshkumar Kuppusamy  1 , Suneeth P Lazarus  1
Affiliations

Comparison of erector spinae plane block and local anaesthetic infiltration of the incision site for postoperative analgesia in percutaneous nephrolithotomy - A randomised parallel-group study

Srinivasan Ramachandran et al. Indian J Anaesth. 2021 May.

Abstract

Background and aims: Erector spinae plane block (ESPB) has been found effective in providing postoperative analgesia following a myriad of surgeries. This study was designed to evaluate the effectiveness of ultrasonography (USG) guided erector spinae plane block to provide postoperative analgesia following percutaneous nephrolithotomy (PCNL).

Methods: This was a prospective, double-blinded, randomised parallel-group study conducted in patients undergoing PCNL. Patients in Group C (n = 33) received subcutaneous infiltration of 20 mL of 0.25% bupivacaine at the incision site and Group B (n = 33) received USG guided ESPB with 20 mL of 0.25% bupivacaine postoperatively. Numeric rating scale (NRS) scores were assessed at intervals of 30 min, 60 min, then hourly for six h, followed by four-hourly up to 24 h. The primary objective of the study was to compare postoperative pain relief using the NRS score between the two groups. Secondary objectives were to compare the analgesic requirement and to assess the incidence of complications. Normally distributed data were expressed as mean and standard deviation and analysed using Student's t-test. Data following non-normal distribution were expressed as median and interquartile range and analysed using Mann- Whitney U-test. For categorical data, the Chi-square test was used.

Results: NRS scores were lower in Group B than Group C. There was significant prolongation in time for first analgesia in Group B (12 h) compared to Group C (30 min). There was a significant reduction in total tramadol consumption at 24 h postoperatively in the ESPB group.

Conclusion: Ultrasound-guided ESPB is an efficacious analgesic technique with an opioid-sparing effect following PCNL.

Keywords: Erector spinae plane block; interventional ultrasonography; percutaneous nephrolithotomy; postoperative pain.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Sonographic landmarks at the level of T10. (b) Image showing needle advancement towards transverse process and local anesthetic spread below erector spinae muscle. (TM- Trapezius muscle, ESM- Erector spinae muscle, TP- Transverse process. LA- Local anaesthetic, arrows indicate needle path)
Figure 2
Figure 2
CONSORT flow diagram
See this image and copyright information in PMC

References

    1. Wang J, Zhang C, Tan D, Tan G, Yang B, Chen W, et al. The effect of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy: A systematic review and meta-analysis. Urol Int. 2016;97:125–33. - PubMed
    1. Parikh GP, Shah VR, Vora KS, Parikh BK, Modi MP, Kumari P. Ultrasound guided peritubal infiltration of 0.25% Bupivacaine versus 0.25% Ropivacaine for postoperative pain relief after percutaneous nephrolithotomy: A prospective double blind randomised study. Indian J Anaesth. 2014;58:293–7. - PMC - PubMed
    1. Jonnavithula N, Chirra RR, Pasupuleti SL, Devraj R, Sriramoju V, Pisapati MV. A comparison of the efficacy of intercostal nerve block and peritubal infiltration of ropivacaine for postoperative analgesia following percutaneous nephrolithotomy: A prospective randomised double-blind study. Indian J Anaesth. 2017;61:655–60. - PMC - PubMed
    1. Hatipoglu Z, Gulec E, Turktan M, Izol V, Arıdogan A, Gunes Y, et al. Comparative study of ultrasound-guided paravertebral block versus intravenous tramadol for postoperative pain control in percutaneous nephrolithotomy. BMC Anesthesiol. 2018;18:24. - PMC - PubMed
    1. Parikh DA, Patkar GA, Ganvir MS, Sawant A, Tendolkar BA. Is segmental epidural anaesthesia an optimal technique for patients undergoing percutaneous nephrolithotomy? Indian J Anaesth. 2017;61:308–14. - PMC - PubMed