Ultrasound-guided erector spinae plane block versus intravenous patient-controlled analgesia in percutaneous nephrolithotomy

INTRODUCTION: Intravenous (IV) patient-controlled analgesia (PCA) is frequently used to optimize postoperative analgesia in many surgeries. In recently, ultrasound-guided erector spinae plane block (ESPB) has begun to be widely used. Does ease of application, fewer complications and providing effective analgesia with a single injection make it more advantageous in postoperative pain management? The aim of this study is to compare the postoperative analgesic efficacy of the ultrasound-guided ESPB with that of the IV PCA in percutaneous nephrolithotomy surgery.
METHODS: Sixty participants selected for elective percutaneous nephrolithotomy were included in this study. The patients were randomized into two groups using a closed-envelope method. An ultrasound-guided ESPB was applied with 20 mL of the local anesthetic mixture at the T-7 level in group ESPB. In the PCA group a loading dose of 50 mg tramadol was administered 10 minutes before extubation. Following the extubation, PCA was initiated with a 20 mg bolus, a 30minute lockout period, with a 4hour tramadol limit of 200 mg, and a basal infusion rate of 5 mg/hour.
RESULTS: Demographic data and ASA scores of the groups were similar. In the ESPB group, VAS scores, and analgesic requirement were significantly lower, and patient satisfaction were higher in the first 6hours postoperatively. However, in the PCA group, VAS score and analgesic requirement were lower than group ESP at the 12th hour postoperatively.
DISCUSSION AND CONCLUSION: ESP block and iv PCA are effective in PNL surgery. We believe that the ESP block performed under USG guidance is more effective and advantageous in the first 6 hours.