Postoperative Pain Relief Following Lumbar Erector Spinae Plane Block in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial.

OBJECTIVE: To test whether lumbar Erector Spinae Plane Block (ESPB) provides superior analgesia compared to placebo in patients undergoing Percutaneous Nephrolithotomy (PCNL), using reduction in postoperative opioid consumption, delay in rescue analgesia demand and reduction of pain scores as outcome measures. METHODS: 34 adult (18-60 years) ASA I and II patients undergoing unilateral PCNL were randomized into two groups (Bupivacaine and Saline) - both receiving ipsilateral ESPB at L1 vertebral level with either 20 ml 0.25% Inj. Bupivacaine or 20 ml normal saline respectively, at the start of the surgery under general anesthesia. The primary outcome measure was total 24-hour rescue opioid analgesic requirement, while time to first demand of rescue analgesic and pain scores at 2, 12 and 24 hours postoperatively were secondary outcomes. RESULTS: The 24-hour requirement of rescue analgesic Tramadol was significantly lower (53.5 ± 29.6 vs 121.2 ± 51.1 mg) [mean ± SD] (P = .001) and time to first demand of rescue analgesia was more (14.1 ± 8.4 vs 6.0 ± 5.6 hours) [mean ± SD] (P = .001) in the Bupivacaine group as compared to placebo. The pain scores were significantly lower in the Bupivacaine group at 12-hour post-operatively [4 (3,4) vs 5.5 (5,6)] [median (IQR)] (P = .001), while the stone-load, surgical duration and intraoperative opioid use were comparable between the two groups and no block-related complications were noted in any patient. CONCLUSION: Post-PCNL, ipsilateral lumbar ESPB reduced 24-hour opioid consumption and delayed time to demand for rescue analgesia as compared to placebo.

Efficacy of PCNL in the resolution of symptoms of nephrolithiasis.

Patients undergo Percutaneous Nephrolithotomy (PCNL) for the resolution of pain, but at times, other symptoms such as hematuria, dysuria, nausea, emotional distress, and anxiety are also the presenting symptoms. While pain resolution after successful surgery is generally the focus, the resolution rate of other symptoms after surgery is not described. Our study aims to determine the efficacy of PCNL for the resolution of other symptoms. Patients aged > 18 years who underwent PCNL from September 2019 to 2021 were interviewed face-to-face and asked questions regarding their symptoms before and 3 months after the surgery. Their response was noted on an 11-point Numerical-Rating-Scale (NRS) of 0-10. The primary outcome was symptom resolution rate at 3 months after PCNL. The secondary outcomes were rate of resolution of gross hematuria, dysuria, anorexia and nausea, emotional distress and anxiety, work interference, and daily routine activities. Only patients who had complete stone clearance in a single sitting were included. Of the total 110 patients, almost half (45.45%) of the patients reported having one or more symptoms at or after 3 months of surgery. The reduction in proportion of patients and mean difference in preoperative and postoperative NRS scores of symptoms were statistically significant. Symptoms that persisted were mild and posed slight discomfort to the patient. Complete resolution of all the symptoms may not be achieved even in patients who have complete clearance after PCNL, and a few symptoms can persist, however, only mild. Appropriate preoperative counselling of the patients is, therefore, essential.