Shankar K, Rangalakshmi Srinivasan, Priyanka D, Kailash P, Deepak Vijaykumar Kadlimatti
Department of Anaesthesia and Critical Care, Rajarajeswari Medical College and Hospital, Kambipura, Mysore Road, Bangalore, Karnataka, India.
J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):586-591. doi: 10.4103/joacp.JOACP_64_20. Epub 2022 Jan 6.
In percutaneous nephrolithotomy (PCNL), distension of renal capsule, pelvicalyceal system and nephrostomy tube causes intense postoperative pain. The present study was done to compare the efficacy of peritubal infiltration of Ropivacaine with Dexmedetomidine and ultrasound guided single level T10 paravertebral block for post-operative analgesia in patients undergoing PCNL.
A prospective, double blind study was conducted on 60 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing PCNL who were randomized into 3 groups. Group PV [ = 20] received paravertebral block at T 10 level with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group PT [ = 20] received peritubal infiltration along nephrostomy tube with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group C [ = 20] control group received intravenous Tramadol 1mg/kg. Postoperative pain scores, opioid consumption and side effects if any were recorded for 24 hrs. Statistical analysis was done using ANOVA test, Chi-square test. value <0.05 was considered significant.
Demographic data were comparable. Reduced dynamic VAS score was noted for first 8hrs in peritubal infiltration compared to paravertebral group. Dynamic VAS scores were significantly lower in paravertebral group at 8, 12 and 24 hr as compared to peritubal infiltration ( < 0.05). During all time intervals peritubal infiltration and paravertebral group had significantly lower VAS scores as compared to control group. Opioid requirement was more in control group compared to study groups.
In PCNL, peritubal infiltration and single level paravertebral block produces effective postoperative analgesia without significant side effects.
在经皮肾镜取石术（PCNL）中，肾包膜、肾盂肾盏系统和肾造瘘管的扩张会导致术后剧痛。本研究旨在比较罗哌卡因联合右美托咪定的肾周浸润与超声引导下T10单节段椎旁阻滞用于PCNL患者术后镇痛的效果。
对60例年龄在18至65岁之间、美国麻醉医师协会（ASA）分级为I级和II级、接受PCNL的患者进行了一项前瞻性双盲研究，这些患者被随机分为3组。PV组[ = 20]接受T10节段椎旁阻滞，注射20 ml 0.25%罗哌卡因加0.25 mcg/kg右美托咪定。PT组[ = 20]沿肾造瘘管进行肾周浸润，注射20 ml 0.25%罗哌卡因加0.25 mcg/kg右美托咪定。C组[ = 20]为对照组，静脉注射曲马多1mg/kg。记录术后24小时的疼痛评分、阿片类药物用量及任何副作用。采用方差分析、卡方检验进行统计学分析。P值<0.05被认为具有统计学意义。
人口统计学数据具有可比性。与椎旁阻滞组相比，肾周浸润组在最初8小时的动态视觉模拟评分（VAS）降低。与肾周浸润组相比，椎旁阻滞组在8、12和24小时的动态VAS评分显著更低（P < 0.05）。在所有时间段内，肾周浸润组和椎旁阻滞组的VAS评分均显著低于对照组。与研究组相比，对照组的阿片类药物需求量更大。
在PCNL中，肾周浸润和单节段椎旁阻滞可产生有效的术后镇痛，且无明显副作用。
