The erector spinae plane block reduces breakthrough pain after percutaneous nephrolithotomy

ABSTRACT

INTRODUCTION AND OBJECTIVE: Inadequate pain control is a major barrier to same-day discharge after percutaneous nephrolithotomy (PCNL). This study was designed to evaluate whether the novel thoracic erector spinae plane block (ESPB) can reduce postoperative breakthrough pain and eliminate the need for intravenous (IV) opioids after PCNL. METHODS: A prospective cohort study of adult patients undergoing percutaneous nephrolithotomy (PCNL) was conducted at our institution from May 2020 to January 2021. Patients with a history of chronic pain and opioid use were excluded from the study. Participants in the intervention group received an ultrasound-guided T11 erector spinae plane block prior to the start of the procedure. Patients were admitted postoperatively and prescribed an oral pain regimen;IV opioids were prescribed only upon request. Verbal pain score ≥7) and opioid administration within 24 hours were analyzed as the primary outcome. RESULTS: A total of 56 patients undergoing PCNL were included in our study, of whom 23 successfully received ESPB. We found that 78% of patients in the ESPB group compared to 47% in the control group were successfully managed with oral analgesics alone without IV opioids or breakthrough pain (p=0.03). Although no difference in total 24-hour opioid usage was detected, ESPB significantly lowered the odds of having breakthrough pain after adjusting for factors such as age, sex, dilated tract size, and tract location (OR 0.21, 95% CI 0.050-0.78). CONCLUSIONS: ESPB greatly reduces breakthrough pain and IV opioid use after PCNL, and most patients who receive an ESPB can be managed with oral analgesics alone. The ESPB can be performed by urologists or by the regional pain specialists as part of a routine perioperative workflow. This holds great promise in facilitating sameday discharge after PCNL, a benefit that is especially impactful in the COVID-19 era.