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Ultrasound-guided low thoracic paravertebral block versus peritubal infiltration for percutaneous nephrolithotomy: a prospective randomized study

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Abstract

The aim of this study was to investigate the efficacy of peritubular infiltration and ultrasound-guided low thoracal paravertebral block in patients undergoing percutaneous nephrolithotomy (PCNL). Sixty patients, American Society of Anesthesiologists I–II, between the ages of 18 and 65 years undergoing PCNL were randomized into three groups. Group peritubal infiltration (Pi, n = 20) received infiltration along the nephrostomy tube 20 ml 0.25% bupivacaine, in 6 and 12 o’clock position. Group paravertebral block (Pv, n = 20) received single-shot paravertebral block with 20 ml 0.25% bupivacaine at the level of T8–T9. Group control (C, n = 20): no intervention is performed. Postoperative opioid consumption and pain scores, opioid-related side effects, and additional analgesic requirement were recorded. The fentanyl consumption in Group Pv was significantly lower in comparison to Group C in all time intervals (p < 0.05). In the comparison of Group Pv and Group Pi, fentanyl consumptions in the postoperative 0–4th hours (100.00 ± 50.65 and 145.00 ± 61.55, respectively), 4–8th hours (50.00 ± 64.88 and 121.25 ± 56.93 respectively), and in the total of 24 h (197.50 ± 133.74 and 368.75 ± 116.66 respectively) were significantly lower in Group Pv (p < 0.05). The dynamic VAS scores analyzed at the 1st and 2nd hours were significantly lower in Group Pv than Group Pi (p < 0.05). Eight patients in Group C, two patients in Group Pi and 1 patient in Group Pv required additional analgesics and the difference was significant (p < 0.05). Paravertebral block achieved more effective analgesia by reducing postoperative opioid consumption and VAS scores comparison to the control and peritubal infiltration groups in patients undergoing percutaneous nephrolithotomy.

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References

  1. Preminger GM (2010) Percutaneous nephrolithotomy: an extreme technical makeover for an old technique. Arch Ital Urol Androl 82 (1):23–25

    PubMed  Google Scholar 

  2. Ramakumar S, Segura JW (2000) Renal calculi. Percutaneous management. Urol Clin N Am 27(4):617–622

    Article  CAS  Google Scholar 

  3. Wang J, Zhang C, Tan D, Tan G, Yang B, Chen W, Tang G (2016) The effect of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Int 97(2):125–133. https://doi.org/10.1159/000447306

    Article  CAS  PubMed  Google Scholar 

  4. Parikh GP, Shah VR, Modi MP, Chauhan NC (2011) The analgesic efficacy of peritubal infiltration of 0.25% bupivacaine in percutaneous nephrolithotomy—a prospective randomized study. J Anaesthesiol Clin Pharmacol 27(4):481–484. https://doi.org/10.4103/0970-9185.86591

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ak K, Gursoy S, Duger C, Isbir AC, Kaygusuz K, Ozdemir Kol I, Gokce G, Mimaroglu C (2013) Thoracic paravertebral block for postoperative pain management in percutaneous nephrolithotomy patients: a randomized controlled clinical trial. Med Princ Pract 22(3):229–233. https://doi.org/10.1159/000345381

    Article  CAS  PubMed  Google Scholar 

  6. Aravantinos E, Kalogeras N, Stamatiou G, Theodorou E, Moutzouris G, Karatzas A, Melekos M (2009) Percutaneous nephrolithotomy under a multimodal analgesia regime. J Endourol 23(5):853–856. https://doi.org/10.1089/end.2008.0448

    Article  PubMed  Google Scholar 

  7. Ahiskalioglu A, Ahiskalioglu EO, Dostbil A, Abdullah C, Aksoy M, Celik M, İnce İ, Kursad H (2016) The effect of epidural levobupivacaine and fentanyl on stress response and pain management in patients undergoing percutaneous nephrolithotomy. West Indian Med J. https://doi.org/10.7727/wimj.2015.095

    Article  Google Scholar 

  8. McHugh GA, Thoms GM (2002) The management of pain following day-case surgery. Anaesthesia 57(3):270–275

    Article  CAS  Google Scholar 

  9. Borle AP, Chhabra A, Subramaniam R, Rewari V, Sinha R, Ramachandran R, Kumar R, Seth A (2014) Analgesic efficacy of paravertebral bupivacaine during percutaneous nephrolithotomy: an observer blinded, randomized controlled trial. J Endourol 28(9):1085–1090. https://doi.org/10.1089/end.2014.0179

    Article  PubMed  Google Scholar 

  10. Wauters JP (1991) Renal complications due to non-steroidal anti-inflammatory drugs: mechanism and clinical implications. Schweiz Med Wochenschr 121(15):513–516

    CAS  PubMed  Google Scholar 

  11. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA (2000) Thoracic paravertebral block for breast surgery. Anesth Analg 90(6):1402–1405

    Article  CAS  Google Scholar 

  12. Jamieson BD, Mariano ER (2007) Thoracic and lumbar paravertebral blocks for outpatient lithotripsy. J Clin Anesth 19(2):149–151. https://doi.org/10.1016/j.jclinane.2006.07.006

    Article  PubMed  Google Scholar 

  13. El-Boghdadly K, Madjdpour C, Chin KJ (2016) Thoracic paravertebral blocks in abdominal surgery—a systematic review of randomized controlled trials. Br J Anaesth 117(3):297–308. https://doi.org/10.1093/bja/aew269

    Article  CAS  PubMed  Google Scholar 

  14. Dalela D, Goel A, Singh P, Shankhwar SN (2004) Renal capsular block: a novel method for performing percutaneous nephrolithotomy under local anesthesia. J Endourol 18(6):544–546. https://doi.org/10.1089/end.2004.18.544

    Article  CAS  PubMed  Google Scholar 

  15. Ead H (2006) From Aldrete to PADSS: reviewing discharge criteria after ambulatory surgery. J Perianesth Nurs 21(4):259–267. https://doi.org/10.1016/j.jopan.2006.05.006

    Article  PubMed  Google Scholar 

  16. Kehlet H, Holte K (2001) Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87(1):62–72

    Article  CAS  Google Scholar 

  17. American Society of Anesthesiologists Task Force on Acute Pain Management (2012) Acute pain management in the perioperative setting: an updated report by the. Anesthesiology 116(2):248–273. https://doi.org/10.1097/ALN.0b013e31823c1030

    Article  Google Scholar 

  18. Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC (2001) Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology 58(3):345–350

    Article  CAS  Google Scholar 

  19. Pietrow PK, Auge BK, Lallas CD, Santa-Cruz RW, Newman GE, Albala DM, Preminger GM (2003) Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol 17(6):411–414. https://doi.org/10.1089/089277903767923218

    Article  PubMed  Google Scholar 

  20. Rudkin GE, Gardiner SE, Cooter RD (2008) Bilateral thoracic paravertebral block for abdominoplasty. J Clin Anesth 20(1):54–56. https://doi.org/10.1016/j.jclinane.2007.06.020

    Article  PubMed  Google Scholar 

  21. Navlet MG, Garutti I, Olmedilla L, Perez-Pena JM, San Joaquin MT, Martinez-Ragues G, Gomez-Caro L (2006) Paravertebral ropivacaine, 0.3%, and bupivacaine, 0.25%, provide similar pain relief after thoracotomy. J Cardiothorac Vasc Anesth 20(5):644–647. https://doi.org/10.1053/j.jvca.2006.02.032

    Article  CAS  PubMed  Google Scholar 

  22. Liu Y, Yu X, Sun X, Ling Q, Wang S, Liu J, Luo A, Tian Y, Mei W (2016) Paravertebral block for surgical anesthesia of percutaneous nephrolithotomy: care-compliant 3 case reports. Medicine (Baltimore) 95(28):e4156. https://doi.org/10.1097/md.0000000000004156

    Article  CAS  Google Scholar 

  23. Krediet AC, Moayeri N, van Geffen GJ, Bruhn J, Renes S, Bigeleisen PE, Groen GJ (2015) Different approaches to ultrasound-guided thoracic paravertebral block: an illustrated review. Anesthesiology 123(2):459–474. https://doi.org/10.1097/aln.0000000000000747

    Article  PubMed  Google Scholar 

  24. Karmakar FRCAManoj K (2001) Thoracic Paravertebral block. Anesthesiology 95(3):771–780

    Article  Google Scholar 

  25. Pace MM, Sharma B, Anderson-Dam J, Fleischmann K, Warren L, Stefanovich P (2016) Ultrasound-guided thoracic paravertebral blockade: a retrospective study of the incidence of complications. Anesth Analg 122(4):1186–1191. https://doi.org/10.1213/ane.0000000000001117

    Article  PubMed  Google Scholar 

  26. Cowie B, McGlade D, Ivanusic J, Barrington MJ (2010) Ultrasound-guided thoracic paravertebral blockade: a cadaveric study. Anesth Analg 110(6):1735–1739. https://doi.org/10.1213/ANE.0b013e3181dd58b0

    Article  PubMed  Google Scholar 

  27. Kamble TS, Deshpande CM (2016) Evaluation of the efficacy of bupivacaine (0.5%) alone or with clonidine (1 mug/kg) versus control in a single level paravertebral blockin patients undergoing PCNL procedure. J Clin Diagn Res 10(12):UC13–UC17. https://doi.org/10.7860/jcdr/2016/20890.9033

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Gokten OE, Kilicarslan H, Dogan HS, Turker G, Kordan Y (2011) Efficacy of levobupivacaine infiltration to nephrosthomy tract in combination with intravenous paracetamol on postoperative analgesia in percutaneous nephrolithotomy patients. J Endourol 25(1):35–39. https://doi.org/10.1089/end.2010.0346

    Article  PubMed  Google Scholar 

  29. Parikh GP, Shah VR, Vora KS, Parikh BK, Modi MP, Panchal A (2013) Ultrasound guided peritubal infiltration of 0.25% ropivacaine for postoperative pain relief in percutaneous nephrolithotomy. Middle East J Anaesthesiol 22(2):149–154

    PubMed  Google Scholar 

  30. Parikh GP, Shah VR, Vora KS, Modi MP, Mehta T, Sonde S (2013) Analgesic efficacy of peritubal infiltration of ropivacaine versus ropivacaine and morphine in percutaneous nephrolithotomy under ultrasonic guidance. Saudi J Anaesth 7(2):118–121. https://doi.org/10.4103/1658-354x.114046

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bouman EA, Theunissen M, Kessels AG, Keymeulen KB, Joosten EA, Marcus MA, Buhre WF, Gramke HF (2014) Continuous paravertebral block for postoperative pain compared to general anaesthesia and wound infiltration for major oncological breast surgery. SpringerPlus 3:517. https://doi.org/10.1186/2193-1801-3-517

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sidiropoulou T, Buonomo O, Fabbi E, Silvi MB, Kostopanagiotou G, Sabato AF, Dauri M (2008) A prospective comparison of continuous wound infiltration with ropivacaine versus single-injection paravertebral block after modified radical mastectomy. Anesth Analg 106(3):997–1001. https://doi.org/10.1213/ane.0b013e31816152da table of contents.

    Article  CAS  PubMed  Google Scholar 

  33. Visoiu M, Cassara A, Yang CI (2015) Bilateral paravertebral blockade (T7–10) versus incisional local anesthetic administration for pediatric laparoscopic cholecystectomy: a prospective, randomized clinical study. Anesth Analg 120(5):1106–1113. https://doi.org/10.1213/ane.0000000000000545

    Article  CAS  PubMed  Google Scholar 

  34. Zhang X, Shu L, Lin C, Yang P, Zhou Y, Wang Q, Wu Y, Xu X, Cui X, Lin X, Jin L, Li T (2015) Comparison between intraoperative two-space injection thoracic paravertebral block and wound infiltration as a component of multimodal analgesia for postoperative pain management after video-assisted thoracoscopic lobectomy: a randomized controlled trial. J Cardiothorac Vasc Anesth 29(6):1550–1556. https://doi.org/10.1053/j.jvca.2015.06.013

    Article  PubMed  Google Scholar 

  35. Bansal P, Saxena KN, Taneja B, Sareen B (2012) A comparative randomized study of paravertebral block versus wound infiltration of bupivacaine in modified radical mastectomy. J Anaesthesiol Clin Pharmacol 28(1):76–80. https://doi.org/10.4103/0970-9185.92449

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Karmakar MK, Gin T, Ho AM (2001) Ipsilateral thoraco-lumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection. Br J Anaesth 87(2):312–316

    Article  CAS  Google Scholar 

  37. Saito T, Gallagher ET, Cutler S, Tanuma K, Yamada K, Saito N, Maruyama K, Carlsson C (1996) Extended unilateral anesthesia. New technique or paravertebral anesthesia? Reg Anesth 21(4):304–307

    CAS  PubMed  Google Scholar 

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Acknowledgements

Special thanks to “Ufuk Demir, Omer Doymus, and Mursel Ekinci” for their guidance and supports.

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Authors and Affiliations

  1. Department of Anesthesiology, Regional Training and Research Hospital, Erzurum, Turkey

    Ahmet Murat Yayik & Elif Oral Ahiskalioglu

  2. Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey

    Ahmet Murat Yayik, Ali Ahiskalioglu, Haci Ahmet Alici & Husnu Kursad

  3. Department of Urology, Ataturk University School of Medicine, Erzurum, Turkey

    Saban Oguz Demirdogen

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  1. Ahmet Murat Yayik
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Correspondence to Ahmet Murat Yayik.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Yayik, A.M., Ahiskalioglu, A., Demirdogen, S.O. et al. Ultrasound-guided low thoracic paravertebral block versus peritubal infiltration for percutaneous nephrolithotomy: a prospective randomized study. Urolithiasis 48, 235–244 (2020). https://doi.org/10.1007/s00240-018-01106-w

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