Prasad Mukesh K, Varshney Rohit K, Jain Payal, Choudhary Amit K, Khare Aditi, Jheetay Gurdeep S
Department of Anaesthesia and Pain, Teerthankar Mahaveer Medical College, Moradbad, Uttar Pradesh, India.
Consultant Anaesthesiologist, Indra Memorial Hospital, Patna, Bihar, India.
Saudi J Anaesth. 2020 Oct-Dec;14(4):480-486. doi: 10.4103/sja.SJA_26_20. Epub 2020 Sep 24.
Percutaneous nephrolithotomy (PCNL) a minimally invasive method for the removal of renal calculi and is associated with significant pain in postoperative period. Conventionally, intravenous opioids, local anesthetic infiltration, and regional blocks (intercostal/paravertebral blocks) have been tried with less efficacy to control postoperative pain. The present study is conducted to assess the effectiveness of erector spinae plane block (ESPB) performed under fluoroscopy guidance for postoperative analgesia during PCNL.
After obtaining ethical clearance, the study was conducted on 61 American Society of Anaesthesiologists (ASA) I and II patients aged between 18-65 years admitted for PCNL. Group I ( = 30) did not receive ESPB while Group II ( = 31) received ESPB under fluoroscopy guidance and 20 ml of 0.375% ropivacaine was administered after PCNL. Patient-reported pain intensity using visual analogue scale (VAS) was considered as a primary outcome. The hemodynamic variables (heart rate, systolic, diastolic, and mean blood pressure) was considered as a secondary outcome. Statistical analysis was performed using Student's -test and Mann-Whitney U test. Data analysis was performed using the Statistical Package for the Social Sciences version 23.0.
Postoperatively VAS score was significantly lower in Group II at 0, 1, 2, 3, 4, 6, 12, 18, and 24 hours after PCNL ( < 0.001). Dose of rescue analgesia significantly decreased in Group II compared to Group I.
ESPB performed under fluoroscopic guidance is a simple and effective technique and it provides significantly better postoperative pain relief.
经皮肾镜取石术（PCNL）是一种用于清除肾结石的微创方法，术后会伴有明显疼痛。传统上，曾尝试使用静脉注射阿片类药物、局部麻醉药浸润和区域阻滞（肋间/椎旁阻滞）来控制术后疼痛，但效果欠佳。本研究旨在评估在透视引导下进行竖脊肌平面阻滞（ESPB）用于PCNL术后镇痛的有效性。
获得伦理批准后，对61例年龄在18 - 65岁、因PCNL入院的美国麻醉医师协会（ASA）I级和II级患者进行了研究。第一组（n = 30）未接受ESPB，而第二组（n = 31）在透视引导下接受ESPB，并在PCNL术后给予20 ml 0.375%的罗哌卡因。使用视觉模拟量表（VAS）评估患者报告的疼痛强度作为主要结局。将血流动力学变量（心率、收缩压、舒张压和平均血压）作为次要结局。采用学生t检验和曼 - 惠特尼U检验进行统计分析。使用社会科学统计软件包第23.0版进行数据分析。
PCNL术后0、1、2、3、4、6、12、18和24小时，第二组的VAS评分显著低于第一组（P < 0.001）。与第一组相比，第二组的补救镇痛剂量显著降低。
在透视引导下进行的ESPB是一种简单有效的技术，能显著改善术后疼痛缓解情况。
