Paravertebral Block Versus Erector Spinae Plain Block In Percutaneous Nephrolithotomy
Condition: Renal Stone; Nephrolithiasis; Analgesia; Anesthesia
MeSH terms: Nephrolithiasis; Kidney Calculi
Study type: Interventional

Summary: 
      Nowadays, Percutaneous Nephrolithotomy (PCNL) has been the surgical procedure of choice for
      renal stones larger than 2cm or staghorn stones. Yet, the associated postoperative pain is a
      major drawback. The regional anesthetic management of pain in PCNL operation has been of
      great concern. The introduction of ultrasound guided erector spinae plane block and
      paravertebral plane block has been under great focus regarding the efficacy of postoperative
      pain management. Paravertebral plane block (PVB) is a regional nerve block technique that
      depends on local anesthetic injection adjacent to the vertebra to block spinal nerve roots in
      a dermatomal distribution. Erector spinae plane block (ESPB) is a newer regional anesthesia
      technique that depends on injecting local anesthetic (LA) in a plane between the transverse
      process and erector spinae muscle. The LA diffuses into the paravertebral space and spreads
      on both rami (dorsal and ventral) of spinal nerves through spaces between adjoining
      vertebrae.

      The aim of this study is to compare the effect of ultrasound guided Paravertebral blockade
      versus Erector spinae blockade on postoperative opioid use as well as postoperative pain
      control in patients undergoing unilateral PCNL.
    


Intervention name(s): Erector Spinae Plain Block; Paravertebral Block
Intervention type(s): Procedure; Procedure
Intervention description(s): Using aseptic technique, ultrasound-guided ESPB will be performed with the patient in sitting position. The spinous process of the vertebra and a point 3 cm lateral to it will be marked before performing the block. The needle will be inserted and advanced under sono-visualization to contact the transverse process of the vertebra. After negative aspiration, LA will be deposited into the fascial plane deep to erector spinae muscle.
30 ml of Bupivacaine 0.25% will be used as LA, injected using a 22-gauge spinal needle at the level of T10 which will be identified by counting 3 spinous processes below T7 which is at the level of the inferior angle of the scapula and also rechecked by counting down from C7.
Patients will then receive general anesthesia. All patients will receive paracetamol (1gm/8hrs IV) as a regular analgesia. IV morphine (0.02mg/kg) will be given as a rescue analgesia if the Visual Analogue Scale for pain is ≥ 4.; Using sterile technique, ultrasound scanning of thoracic paravertebral space will be done in sitting position. The transverse process will be identified as hyperechoic structure while pleura will be identified as a mobile hypoechoic structure. The needle will be inserted cranio-caudal and advanced under sono-visualization to the identified thoracic paravertebral space. After negative aspiration, LA will be deposited displacing the pleura.
30 ml of Bupivacaine 0.25% will be used as LA, injected using a 22-gauge spinal needle at the level of T10 which will be identified by counting 3 spinous processes below T7 which is at the level of the inferior angle of the scapula and also rechecked by counting down from C7.
Patients will then receive general anesthesia. All patients will receive paracetamol (1gm/8hrs IV) as a regular analgesia. IV morphine (0.02mg/kg) will be given as a rescue analgesia if the Visual Analogue Scale for pain is ≥ 4.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Erector spinae plain block; Paravertebral block; Ultrasound-guided; Percutaneous nephrolithotomy; Analgesia