Abstract

Percutaneous nephrolithotomy (PCNL) involves significant postoperative pain and discomfort. The present study compared the effectiveness of two novel techniques to alleviate postoperative pain following PCNL surgery, namely anatomical landmark guided erector spinae plane block (ESPB) versus peritubal infiltration of local anesthetic. Methods: This was a prospective, observer blind, randomized controlled trial in adult patients undergoing PCNL under general anesthesia. Patients were randomized to two groups of 39 each – one undergoing ESPB with 0.25% levobupivacaine (Group A), and the other receiving peritubal infiltration from renal capsule to skin postoperatively (Group B), with the same local anesthetic. Duration of postoperative analgesia (time to first rescue analgesic), visual analog scale (VAS) score assessed at 1, 2, 4, 6, 12, 18, and 24 hours postoperatively and the number of doses of rescue analgesic (IV tramadol) administered in the first 24 hours were recorded. Treatment emergent adverse events were also noted. Results: Duration of satisfactory postoperative analgesia was significantly more in Group B than in Group A (15.2 ± 8.35 hours vs. 6.8 ± 1.89; p < 0.001). Also in Group B, nearly 49% of the subjects required no rescue analgesic in the first 24 hours in contrast to Group A where all subjects required at least one dose of rescue analgesic (p < 0.001). The VAS pain scores were comparable for the first 4 hours but thereafter were higher in those undergoing ESPB. Relatively minor adverse effects were encountered in a few instances in both groups. Conclusions: Anatomical landmark guided ESPB is an effective strategy to provide analgesia in PCNL in the early postoperative period, but peritubal infiltration of local anesthetic provides more durable postoperative analgesia, often alleviating the need for rescue analgesic use in the first 24 hours.

Description