Anterior Quadratus Lumborum Block Versus Erector Spina Plane Block in Percutaneous Nephrolithotomy Surgery
Condition: Anesthesia; Analgesia; Patient Controlled Analgesia; Quadratus Lumborum Block; Erector Spina Plane Block
MeSH terms: Agnosia
Study type: Observational

Summary: 
      In this study, it was aimed to evaluate the effects of anterior quadratus lumborum block
      (QLB3) and Erector Spina Plane Block (ESPB) on postoperative acute pain scores and opioid
      consumption in the first 24 hours in Percutaneous Nephrolithotomy Surgery
    

Detailed description: 
      Percutaneous nephrolithotomy (PCNL) is commonly used to treat large kidney stones. Patients
      usually complain of severe pain and discomfort postoperatively. Postoperative pain prolongs
      hospital stay, delays wound healing, increases infection rates, and increases the incidence
      of drug side effects.

      Regional anesthesia is part of multimodal analgesia in treating postoperative pain. Facial
      plane blocks are among these procedures. Erector spina plane block (ESPB) is a
      peri-paravertebral regional anesthesia technique applied for the first time to treat thoracic
      neuropathic pain. In the literature, the effectiveness of upper abdomen and renal operations
      in pain management has been demonstrated. Quadratus lumborum block (QLB) was first described
      as an alternative to the transversus abdominis plane block. This block can be performed with
      three methods under ultrasound guidance. An anterior QLB (QLB3) block was used in this study.
      In this block, the local anesthetic drug is applied between the quadratus lumborum muscle and
      the psoas muscle fascia and spreads along the thoracolumbar fascia. This block provides
      anesthesia and analgesia in the T7-L1 dermatome area. QLB3 block has been applied in
      pyeloplasty, cholecystectomy, lower abdominal surgeries, cesarean sections, radical
      nephrectomy, and hip joint surgeries and provided adequate postoperative analgesia.

      This study aimed to evaluate the effects of QLB3 block and ESPB block on pain scores and
      opioid consumption in patients undergoing PCNL.

      Patients will be divided into three groups.

      Group QLB3:

      Patients who applied the OLB3 block and IV morphine-patient-controlled analgesia (PCA) before
      PCNL surgery were included in this group.

      Group ESPB:

      Patients who applied ESPB block and IV morphine-PCA before PCNL surgery were included in this
      group.

      Group Control In this group, patients only applied general anesthesia and IV morphine-PCA.
    

Intervention name(s): Group QLB3; Group ESPB; Group Control
Intervention type(s): Procedure; Procedure; Other
Intervention description(s): Patients who applied the QLB3 block before PCNL surgery were included in this group
Multimodal analgesia protocol is applied to all patients undergoing PCNL surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg after induction of general anesthesia and iv paracetamol 1 gr intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv PCA of 0,2mg/ml morphine (the bolus dose is 20 mcg/kg, the lock-in time of 6-10 minutes, and the 4-hour limit is adjusted to be 80% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥4), 100 mg tramadol is administered to patients. The prophylaxis for postoperative nausea and vomiting (PONV) involved the routine administration of 8 mg IV dexamethasone to patients before induction and 0.15 mg/kg IV ondansetron 20 minutes before the end of the procedure.; Patients who applied ESP block before PCNL surgery were included in this group
Multimodal analgesia protocol is applied to all patients undergoing PCNL surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg after induction of general anesthesia and iv paracetamol 1 gr intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv PCA of 0,2mg/ml morphine (the bolus dose is 20 mcg/kg, the lock-in time of 6-10 minutes, and the 4-hour limit is adjusted to be 80% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥4), 100 mg tramadol is administered to patients. The prophylaxis for postoperative nausea and vomiting (PONV) involved the routine administration of 8 mg IV dexamethasone to patients before induction and 0.15 mg/kg IV ondansetron 20 minutes before the end of the procedure.; Patients who did not use block before PCNL surgery were included in this group.
Multimodal analgesia protocol is applied to all patients undergoing PCNL surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg after induction of general anesthesia and iv paracetamol 1 gr intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv PCA of 0,2mg/ml morphine (the bolus dose is 20 mcg/kg, the lock-in time of 6-10 minutes, and the 4-hour limit is adjusted to be 80% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥4), 100 mg tramadol is administered to patients. The prophylaxis for postoperative nausea and vomiting (PONV) involved the routine administration of 8 mg IV dexamethasone to patients before induction and 0.15 mg/kg IV ondansetron 20 minutes before the end of the procedure.
Other intervention name(s): Anterior Quadratus Lumborum Block (QLB3); Erector spina plane block (ESPB); Control
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with undergoing percutaneous nephrolithotomy surgery,
      
Keywords: Anesthesia; Analgesia; Percutaneous Nephrolithotomy Surgery; Patient controlled analgesia; Anterior quadratus lumborum block; Erector spina plane block