Abstract:
Background:
A common minimally invasive surgical technique for treating renal calculi is
percutaneous nephrolithotomy (PCNL), especially in patients with big or complicated
stones.Despite its benefits, postoperative pain remains a significant concern, primarily
due to renal capsule dilation, renal parenchymal tract trauma, and incision site pain.
Effective postoperative pain management is essential to ensure patient comfort, reduce
opioid dependency, enhance early ambulation, and prevent complications related to
inadequate analgesia. Multiple mechanisms involving both somatic and visceral pain
pathways contribute to postoperative pain in PCNL.
This study intends to scientifically analogize ESPB with local anesthetic infiltration for
postoperative analgesia in PCNL patients, addressing existing knowledge gaps and
guiding future clinical practice management in PCNL patients.
Material and Methods:
Following the approval of the College Ethical Committee, 60 patients with ASA
class I-II undergoing PCNL were enrolled in the study after providing informed consent.
They were randomly assigned to either Group A, in which they received 20 ml of 0.25%
bupivacaine with 8 mg of dexamethasone as Local anaesthetic infiltration and Group B
received erector Spinae Planae Block with 20 ml of 0.25% bupivacaine with 8 mg of
dexamethasone.
Postoperative pain relief was compared using the Numeric rating scale (NRS) score
between the two groups at 30 minutes, 60 minutes, and second hourly for 6 hours,
followed by the sixth hourly up to 24 hour. Results:
The mean duration of analgesia was higher in patients who received ESPB (744.03+/-
24.867 in group B) than patients who received Local Anaesthetic infiltration(18.60+/-
1.694 in group A). NRS scores were higher in group A than Group B in the first 24
hours of the postoperative period. The mean time duration to rescue analgesia was
higher in group B than group A.
Conclusion:
Accordant to our study ESPB is an efficacious and safe technique for post operative
analgesia in patients undergoing percutaneous nephrolithotomy. ESPB is a valuable
addition to multimodal analgesia protocols in patients undergoing not only PCNL but
also other urological surgeries. In essence we conclude that USG guided erector spinae
plane block provides adequate analgesia and has an opioid sparing effect in patients
undergoing percutaneous nephrolithotomy surgery.
