Js Medeiros Heitor, Gee Erica, Pak Aimee, Hu Vivian, Crawford Lane, Razavi Sarah, Anderson T Anthony, Sabouri A Sassan
Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA.
Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Cureus. 2024 May 14;16(5):e60272. doi: 10.7759/cureus.60272. eCollection 2024 May.
Percutaneous nephrolithotripsy (PCNL) is a minimally invasive procedure for treating large and complex kidney stones, often resulting in significant post-operative pain and increased opioid use. This study aims to compare pain scores between patients undergoing PCNL who did and did not receive a preoperative single-shot thoracic paravertebral block (PVB) at the post-anesthesia care unit (PACU) as the primary outcome. Secondary outcomes were patient-controlled analgesia (PCA) usage on post-operative day 1 (POD 1), total opioid consumption on PACU and POD 1, and post-operative nausea and vomiting (PONV).
A retrospective cohort study was conducted on the medical records of 341 patients who underwent PCNL from July 2014 to April 2016 in a single major academic center. PVB was administered at thoracic levels T7-9 using a volume of 20 cc of bupivacaine, ranging from 0.25% to 0.5%, to achieve the desired analgesic effect.
After excluding 34 patients, the study included 123 in the no block (NB) group and 149 in the regional anesthesia (RA) group. There were no differences in demographics, including age, sex, weight and height, BMI, and indication for PCNL. The results revealed that the RA group experienced a statistically significant reduction in PCA usage in both crude and adjusted models (adjusted logistic regression analysis: OR = 0.19, 95% CI = 0.05-0.60; p = 0.008). However, there were no significant changes in total opioid consumption, pain scores, or incidents of PONV.
The retrospective analysis did not reveal any discernible advantage in pain management associated with the use of PVB for post-PCNL analgesia, except for reducing the percentage of PCA narcotics used. Future investigations with larger sample sizes and meticulous control for surgical indications and complexity are imperative to accurately assess the efficacy of this block in the context of post-PCNL surgery.
经皮肾镜取石术（PCNL）是一种用于治疗大的和复杂肾结石的微创手术，术后常导致明显疼痛并增加阿片类药物的使用。本研究旨在比较在麻醉后护理单元（PACU）接受和未接受术前单次胸段椎旁阻滞（PVB）的PCNL患者的疼痛评分作为主要结局。次要结局包括术后第1天（POD 1）的患者自控镇痛（PCA）使用情况、PACU和POD 1的总阿片类药物消耗量以及术后恶心呕吐（PONV）。
对2014年7月至2016年4月在一个主要学术中心接受PCNL的341例患者的病历进行回顾性队列研究。使用20 cc布比卡因（浓度范围为0.25%至0.5%）在胸段T7 - 9水平进行PVB，以达到所需的镇痛效果。
排除34例患者后，研究纳入了123例非阻滞（NB）组患者和149例区域麻醉（RA）组患者。在人口统计学特征方面，包括年龄、性别、体重和身高、BMI以及PCNL的适应证，两组之间没有差异。结果显示，在粗模型和校正模型中，RA组的PCA使用量均有统计学意义的显著减少（校正逻辑回归分析：OR = 0.19，95% CI = 0.05 - 0.60；p = 0.008）。然而，总阿片类药物消耗量、疼痛评分或PONV发生率没有显著变化。
回顾性分析未发现与PCNL术后使用PVB进行疼痛管理相关的任何明显优势，除了降低PCA麻醉剂的使用百分比。未来需要进行更大样本量的研究，并对手术适应证和复杂性进行细致控制，以准确评估该阻滞在PCNL术后的疗效。
