Abstract
The Aim: This
prospective, randomised controlled study aimed to investigate the
efficacy and respiratory effects of postoperative pain management with
erector spinae plane block (ESPB) in patients undergoing percutaneous
nephrolithotomy surgery.
Methods : A total of 60
ASA I-II patients aged 18–65 years, scheduled to undergo percutaneous
nephrolithotomy (PCNL) were included. Patients were randomized either to
the ESPB or control group. Ultrasound-guided ESPB with 15mL 0.5%
bupivacaine at the T11 level was performed preoperatively using the
in-plane technique in the ESP group. In both groups, 1gr of intravenous
paracetamol was administered intraoperatively. Postoperative pain and
agitation was evaluated using VAS, Dynamic VAS at 0, 6 and 24 hours and
the Riker sedation-agitation scale at 0th Hours after surgery. Peak
expiratory flow rate(PEFR) and SPO2 were measured in
preoperative examination and at the 0th, 6th, 24th hours
postoperatively. In the postoperative period, intravenous tramadol
(100mg) was administered as a rescue analgesic when VAS ≥ 4. Time and
number of the rescue analgesias, mobilization time and length of
hospital stay were also recorded and analyzed.
Results: A significantly lower VAS and DVAS were observed at
0th, 6th, 24th hours in the ESPB group (p < 0.05 for
each timepoint). Also number of and time to rescue analgesia decreased
in the ESPB group (p< 0.05 and 0.01 respectively).
Postoperative/preoperative PEFR ratio was lower and there were more
agitated patients in control group (p<0.05).
Conclusion: ESPB may have additional clinical advantages while
providing effective analgesia in patients who underwent PCNL comparing
to intravenous analgesia.
Keywords: erector spinae plane block (ESPB); percutaneous
nephrolithotomy (PCNL); Peak expiratory flow rate (PEFR); Riker
sedation-agitation scale