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Paravertebral block for percutaneous nephrolithotomy: a prospective, randomized, double-blind placebo-controlled study

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Abstract

Purpose

Percutaneous nephrolithotomy (PCNL) is performed commonly in patients with large kidney stones, but the management of their postoperative pain presents a major challenge. While it is not routinely performed in PCNL patients, paravertebral block (PVB) has been described as an effective strategy for pain control after various non-urologic surgeries. This trial aims to assess the effect of paravertebral blockade on intraoperative and postoperative opioid use as well as postoperative pain control in patients undergoing PCNL.

Methods

This was a prospective, randomized, double-blind, placebo-controlled study. Patients who consented to participate were randomly assigned to undergo either PVB or a placebo intervention preoperatively. The patient, surgeon, and anesthesia team were all blinded to the randomization. The outcome parameters were intraoperative opioid requirement, postoperative visual analog scale (VAS) pain scores, postoperative opioid use, and postoperative antiemetic use.

Results

23 patients were enrolled in each arm of the study, and the two groups had no significant differences in baseline demographic or clinical characteristics. Patients in the PVB group had significantly lower intraoperative opioid use, postoperative opioid use, frequency of opioid use, and antiemetic. Patients in the PVB group also had lower postoperative VAS pain scores. There were no patients who suffered from complications attributable to PVB.

Conclusion

The results of this randomized, double-blind, placebo-controlled trial suggest that PVB should be considered an effective strategy to reduce opioid requirement and improve pain control for patients undergoing PCNL.

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Author information

Authors and Affiliations

  1. Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA

    Kristin G. Baldea, Parth M. Patel, Grace Delos Santos, Ahmer Farooq, Elizabeth R. Mueller & Thomas M. T. Turk

  2. Department of Urology, University of Michigan, Ann Arbor, MI, USA

    Chandy Ellimoottil

  3. Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA

    Scott Byram

Authors
  1. Kristin G. Baldea
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  2. Parth M. Patel
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  3. Grace Delos Santos
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  4. Chandy Ellimoottil
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  5. Ahmer Farooq
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  6. Elizabeth R. Mueller
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  7. Scott Byram
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  8. Thomas M. T. Turk
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Contributions

KGB: Project development, data collection, data analysis, manuscript writing. PMP: Manuscript writing/editing. GDS: Project development, data collection. CE: Project development, data collection. AF: Data collection, Manuscript editing. ERM: Manuscript editing. SB: Project development, data collection. TMT: Project development, data collection.

Corresponding author

Correspondence to Parth M. Patel.

Ethics declarations

Research involving human participants

Approval for this study for obtained from the Loyola University Chicago Health Sciences Division Institutional Review Board for the Protection of Human Subjects. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Appendix A

Appendix A

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Table 3 Anesthetic protocol for percutaneous nephrolithotomy
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Baldea, K.G., Patel, P.M., Delos Santos, G. et al. Paravertebral block for percutaneous nephrolithotomy: a prospective, randomized, double-blind placebo-controlled study. World J Urol 38, 2963–2969 (2020). https://doi.org/10.1007/s00345-020-03093-3

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  • DOI: https://doi.org/10.1007/s00345-020-03093-3

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