Srinivas Kalabhavi1, Revanasiddappa A. Kanagali2, Bhuvanesa Nanjappa3, Ravi Bhat4, Promod Makanavar5
BACKGROUND
Erector spinae block is a paraspinal, fascial block that targets the ventral, dorsal
rami and rami communications of spinal nerves. The present study was conducted
to know the efficacy of ultrasound guided erector spinae block (ESP) block in
preoperative analgesia among patients with percutaneous nephrolithotomy (PCNL)
attending a tertiary care hospital.
METHODS
The study was carried out on 596 patients from Jan 2015 to Jan 2020 who were
indicated for PCNL. They were divided into two groups, group A (ESP = 373) and
group B (intravenous-IV analgesia = 273). In the group A (N = 373), after
induction of general anaesthesia, ESP block with 0.5 % bupivacaine and 1 /
200,000 epinephrine (single shot) was given at lower thoracic level (T10 - 12) and
IV analgesia was given in group B. All patients were monitored for supplemental
opioid requirement intraoperatively as assessed by their haemodynamic status
(baseline change in heart rate-HR & mean arterial blood pressure-MAP). The
primary outcome of the study was consumption of tramadol in 24 hrs. Pain
assessment every 2-hour pre- and post-operatively using numerical rating (NR)
scale was considered as the secondary outcome. Categorical outcomes were
compared between study groups using chi-square test / Fisher's exact test; Pvalue
of < 0.05 was considered statistically significant using IBM SPSS.
RESULTS
Most of them in group A were free of pain for 24 hours postoperatively with
numerical rating scale score of < 3 and did not require any postop rescue
analgesics. Only 1 patient showed numerical rating scale score of 4 around 16 hrs.
after the surgery and was given tramadol. Supplemental opioid analgesic was not
required by any of the patients during the entire intraoperative period.
CONCLUSIONS
ESP block is a favourable technique that results in very good analgesic effect
preoperatively and also lessens the use of intravenous opioids and other
analgesics.
