Background and aims PCNL is a surgical procedure commonly used to treat large kidney stones. It is usually accompanied by severe pain and chest discomfort postoperatively. the main source of acute pain after PCNL are visceral pain originating from the kidneys and ureters (T10-L2) and somatic pain from the incision site (T8-12).
ESP block is a simple paraspinal, fascial block targeting the ventral, dorsal rami and rami communicates of spinal nerves. We present a series of 5 patients where USG guided ESP block was used as a part of anaesthetic technique (along with GA) in PCNL surgeries as a perioperative analgesia.
Methods After induction of general anaesthesia, ESP block (SINGLE SHOT) was given using 20 ml of 0.375% ropivacaine plus 25 micrograms of dexmedetomidine at lower thoracic level (T10-12). All patients were monitored for supplemental opioid requirement intraoperatively as assessed by their hemodynamic status (baseline change in HR & MAP). Pain was assessed by every 2 hours VAS until 24 h postoperatively.
Results All 4 (out of 5) patients were pain free 24 hours postoperatively with VAS of less than 3 without any postop rescue analgesics requirement. Only 1 patient noticed to have VAS of 4 at 16 h after surgery who required Tramdol. None of the patients required any supplemental opioid analgesic during entire intraoperative period.
Conclusions ESP block is a promising technique, resulting in excellent analgesia in the perioperative period and minimal use of intravenous opioids and other analgesics. We believe that ESP block might be a good option for postoperative analgesia along with stable intraop hemodynamic control after PCNL surgery.
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