Analgesic efficacy of erector spinae plane block in percutaneous nephrolithotomy : A randomized controlled trial.

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.

Efficacy of external nasal nerve block following nasal surgery : A randomized, controlled trial.

BACKGROUND: Pain is the major determinant factor which affects the quality of recovery and postoperative agitation following nasal surgery with the patient under general anesthesia. Our objectives were to test the hypothesis that an external nasal nerve block will decrease pain intensity, decrease drug consumption, decrease the incidence of postoperative emergence agitation and improve quality of recovery. MATERIAL AND METHODS: In this study 100 adult patients who were scheduled for elective external nasal surgery with the patient under general anesthesia and nasal packing on each side, received external nasal nerve blocks postoperatively for 24 h with saline (group I) or 2% xylocaine (group II) with 1:200,000 epinephrine. Postoperative pain was measured at the postanesthesia care unit (PACU) utilizing a visual analog scale (VAS). Narcotics consumption was also measured. Emergence agitation and quality of recovery were also assessed. RESULTS: Pain scores were statistically significant between both groups. Requirements of equivalent morphine doses in the PACU were lower in group II (block) than group I (control) with a significant P value <0.001. Group II (block) patients required significantly less intraoperative fentanyl than group I (control) patients (p = 0.001). Group II (block) showed higher scores in pain dimension of QoR-40 in comparison with group I (P <0.001). The incidence of emergence agitation was lower in group II (block) than in group I (control, 24% vs. 48%, P = 0.012). CONCLUSION: External nasal nerve block is an effective technique for reducing postoperative pain, drug consumption and quality of recovery. It also reduces emergence agitation. The effects are mainly due to profound analgesia and effective pain control that lead to decreased drug usage and reduced discomfort.