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

YAYIK A. M., AHISKALIOĞLU A., Demirdogen S. O., Ahiskalioglu E., Alici H. A., KÜRŞAD H.

UROLITHIASIS, cilt.48, sa.3, ss.235-244, 2020 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 48 Sayı: 3
  • Basım Tarihi: 2020
  • Doi Numarası: 10.1007/s00240-018-01106-w
  • Dergi Adı: UROLITHIASIS
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Sayfa Sayıları: ss.235-244
  • Anahtar Kelimeler: Ultrasound, Paravertebral block, Peritubal infiltration, Percutaneus nephrolithotomy, MULTIMODAL ANALGESIA, WOUND INFILTRATION, PAIN RELIEF, ROPIVACAINE, ANESTHESIA, 0.25-PERCENT, BUPIVACAINE, MANAGEMENT
  • Atatürk Üniversitesi Adresli: Evet

Özet

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.