Evaluation of efficacy of local anaesthetic infiltration of the incision site and erector spinae plane block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy – a randomised open label study.

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.