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Der Anaesthesist

, Volume 68, Issue 11, pp 755–761 | Cite as

Analgesic efficacy of erector spinae plane block in percutaneous nephrolithotomy

A randomized controlled trial
  • M. IbrahimEmail author
  • A. M. Elnabtity
Originalien
  • 117 Downloads

Abstract

Background

The postoperative pain in percutaneous nephrolithotomy (PCNL) is due to dilatation of the renal capsule and the parenchymal tract. The aim of the study was to evaluate the analgesic effect of preoperative single-shot ultrasound(US)-guided erector spinae plane block (ESPB) at theT11 vertebral level in patients undergoing PCNL.

Material and methods

In this prospective randomized controlled study 56 patients were randomized into 2 groups; group B and group C. An erector spinae plane block (ESPB) was performed preoperatively in all patients; patients in group B received 30 ml 0.25% bupivacaine, while patients in group C received 30 ml normal saline as placebo. The following parameters were evaluated: intraoperative fentanyl consumption, time to first use of patient controlled analgesia (PCA), postoperative morphine consumption over 24 h, pain scores at 0, 2, 4, 6, 12 and 24 h, sedation scores at 2, 6, 12 and 24 h, and patient satisfaction.

Results

Patients in group B had lower intraoperative fentanyl consumption (P = 0.01), longer time to first use of PCA (P = 0.01), lower rescue morphine consumption over 24 h (P = 0.002), and higher patient satisfaction scores (P = 0.02). Postoperative numerical rating scale scores were lower in group B at 2 and 12 h (median = 3 and 2, respectively), as opposed to the control group (median = 4 and 3, respectively, P = 0.02). Sedation scores were higher in group C at 2 and 6 h after the procedure (P = 0.02 and 0.03, respectively).

Conclusion

The use of US-guided ESPB provides a good postoperative analgesia and decreases opioid consumption over 24 h in patients undergoing PCNL.

Keywords

Analgesic efficacy Analgesics requirement Morphine consumption Pain relief Postoperative 

Analgetische Wirksamkeit des erector spinae ebene Block in der perkutanen Nephrolithotomie

Eine randomisierte, kontrollierte Studie

Zusammenfassung

Hintergrund

Der postoperative Schmerz nach perkutaner Nephrolithotomie (PCNL) ist bedingt durch eine Dilatation der Nierenkapsel und des Parenchymbereichs. In der vorliegenden Studie wurde der analgetische Effekt eines präoperativen Ultraschall(US)-gesteuerten M.-erector-spinae-Ebenen-Blocks (ESPB) in Einzelapplikation auf Höhe des Wirbels Th11 bei Patienten untersucht, die eine PCNL erhielten.

Material und Methoden

In dieser prospektiven, randomisierten, kontrollierten Studie wurden 56 Patienten in 2 Gruppen randomisiert: Gruppe B und Gruppe C. Ein ESPB wurde präoperativ bei allen Patienten durchgeführt; die Patienten in Gruppe B erhielten 30 ml 0,25% Bupivacain, die Patienten in Gruppe C 30 ml Kochsalzlösung als Plazebo. Folgende Parameter wurden bestimmt: intraoperativer Fentanylverbrauch, Zeit bis zur ersten PCA(Patienten-kontrollierte Analgesie)-Anwendung, postoperativer Morphinverbrauch in den ersten 24 h, Schmerzwerte nach 0, 2, 4, 6, 12 und 24 h, Sedierungswerte nach 2, 6, 12 und 24 h und Patientenzufriedenheit.

Ergebnisse

Bei den Patienten in Gruppe B war der intraoperative Fentanylverbrauch geringer (P = 0,01), die Dauer bis zur ersten PCA-Anwendung länger (P = 0,01), der bedarfsmäßige Morphinverbrauch über 24 h geringer (P = 0,002) und die Patientenzufriedenheit höher (P = 0,02). Die postoperativen Werte auf einer numerischen Rating-Skala waren in Gruppe B nach 2 und 12 h niedriger (Median = 3 bzw. 2) als in der Kontrollgruppe (Median = 4 bzw. 3, P = 0,02). Die Sedierungswerte waren in Gruppe C 2 und 6 h nach dem Eingriff höher (P = 0,02 bzw. 0,03).

Schlussfolgerung

Die Anwendung des US-gesteuerten ESPB bietet eine gute postoperative Analgesie und senkt den Opioidverbrauch über 24 h bei Patienten, die einer PCNL unterzogen werden.

Schlüsselwörter

Analgetische Wirksamkeit Analgetika-Anforderung Morphinverbrauch Schmerzlinderung Postoperativ 

Notes

Compliance with ethical guidelines

Conflict of interest

M. Ibrahim and A. M. Elnabtity declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medicine, Department of AnaesthesiologyZagazig UniversityZagazigEgypt
  2. 2.Al Mashfa health centerKhobarSaudi Arabia

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