Pandey Satya P, Yadav Urvashi, Khan Mohd Mubashir A, Singh Amit K, Verma Shipra, Nigam Shuchi
Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, IND.
Urosurgery, Uttar Pradesh University of Medical Sciences, Etawah, IND.
Cureus. 2023 Jun 9;15(6):e40186. doi: 10.7759/cureus.40186. eCollection 2023 Jun.
Background Percutaneous nephrolithotomy (PCNL) is presently the preferred method for managing renal calculi. Visceral pain from the kidney and ureter and somatic pain from the incision site are the primary causes of immediate postoperative pain following PCNL. Poor pain control is associated with unwanted consequences such as patient discomfort, delayed recovery, and prolonged hospital stay. Recently, the erector spinae plane (ESP) block has been used in many thoracic and abdominal surgeries for the control of postoperative pain. In this study, we aimed to assess the effectiveness of the ultrasound-guided ESP block following PCNL. Methodology This was a prospective, double-blind, randomized controlled study including 60 patients who were scheduled for elective PCNL under general anesthesia. Patients were randomly divided into two groups. Group E underwent an ultrasound-guided ESP block with 20 mL of the local anesthetic mixture at the T-9 level unilaterally on the side of surgery, and group C was a sham group in which 20 mL of normal saline was injected on the side of surgery. Changes in postoperative pain score were the primary outcome, and the duration of analgesia, the total analgesic requirement in 24 hours, and patient satisfaction were the secondary outcomes. Results The demographic data of both groups were comparable. The Visual Analog Scale score was considerably lower in group E than in group C at two, four, six, and eight hours postoperatively. In group E, the mean analgesic duration was substantially longer than that in group C (8.87 ± 2.45 hours vs. 5.67 ± 1.58 hours, respectively). The tramadol requirement was higher in group C (286.67 ± 62.88 mg) than in group E (133.33 ± 47.95 mg) during the 24-hour postoperative period. At 12 hours, patient satisfaction was considerably higher in group E than in group C (6.73 ± 0.45 vs. 5.87 ± 0.35, respectively). Conclusions The ultrasound-guided ESP block provided efficient postoperative pain relief, prolonged duration of analgesia, and reduced tramadol intake after PCNL surgery.
背景 经皮肾镜取石术（PCNL）是目前治疗肾结石的首选方法。肾脏和输尿管的内脏痛以及切口部位的躯体痛是PCNL术后即刻疼痛的主要原因。疼痛控制不佳会带来诸如患者不适、恢复延迟和住院时间延长等不良后果。最近，竖脊肌平面（ESP）阻滞已被用于许多胸腹部手术以控制术后疼痛。在本研究中，我们旨在评估PCNL术后超声引导下ESP阻滞的有效性。
方法 这是一项前瞻性、双盲、随机对照研究，纳入60例计划在全身麻醉下进行择期PCNL的患者。患者被随机分为两组。E组在手术侧T-9水平接受单侧20 mL局部麻醉混合液的超声引导下ESP阻滞，C组为假手术组，在手术侧注射20 mL生理盐水。术后疼痛评分的变化是主要结局，镇痛持续时间、24小时内的总镇痛需求量和患者满意度是次要结局。
结果 两组的人口统计学数据具有可比性。术后2、4、6和8小时，E组的视觉模拟量表评分显著低于C组。在E组，平均镇痛持续时间显著长于C组（分别为8.87±2.45小时和5.67±1.58小时）。术后24小时内，C组的曲马多需求量（286.67±62.88 mg）高于E组（133.33±47.95 mg）。术后12小时，E组的患者满意度显著高于C组（分别为6.73±0.45和5.87±0.35）。
结论 超声引导下的ESP阻滞在PCNL术后提供了有效的疼痛缓解、延长了镇痛持续时间并减少了曲马多的摄入量。
