Investigators' goal is to determine whether Erector Spinae Plane Block would provide a better analgesia, help mobilization and early discharge or increase satisfaction for patients undergoing Percutaneous Nephrolithotomy(PNL). One of the two groups will receive ESP catheterization after general anesthesia conducted. The other group will receive routine analgesia protocol used for PNL. The total amount of drugs administered, pain scores(NRS) at certain time intervals and at certain events(removal of nephrostomy and pain at mobilization) will be recorded and compared.
Erector Spinae Plane Block(ESP) is a rather new method which can block ventral and dorsal rami of spinal nerves in the paravertebral area after they leave the spinal column. Originally used for thoracic somites, by spreading in a craniocaudal fashion in the erector spinae muscle group, it has the potential of blocking cervical or lumbar nerves as well. To provide better analgesia for surgical procedures, anesthesiologists use truncal blocks for peripheral intervention. Although these blocks are generally very effective and easy to apply, they are limited by a relatively small area of effectivity. In order to achieve denser effects for larger surfaces, epidural anesthesia must be used with the risk of more severe complications than any peripheral or truncal nerve blocks. Epidural anesthesia also has the disadvantages of requiring more experience and more cautiousness than ultrasound-guided truncal blocks and risks of an undesirable temporary motor blockade. ESP block could be the answer for better regional analgesia while avoiding motor blockade and complications of epidural anesthesia. The study will have two groups as Block Group(GB) and Control Group(GC) and two periods as during operation and 48 hours after the operation. Every participant will receive Total Intravenous Anesthesia(TIVA) and will be monitored with ECG, non-invasive blood pressure, heart rate, pulse oximeter, and Bispectral Index. Participants in GB will receive ultrasound-guided ESP block catheter after proper maintenance of anesthesia provided. The first period will be during operation. We will evaluate the administered drug amounts per kilogram for each patient. Investigators believe ESP block will help them deliver proper anesthesia with lower dosages. The second period will include postoperative 48 hours. Pain scores(NRS) will be evaluated at certain time intervals and at two critical moments between the two groups. One of the critical moment which patients fear and feel the pain most is the removal time of nephrostomy. The second moment is the first time patients start walking. Rescue analgesia will be ordered on demand for both groups as IV 1 mg/kg tramadol. Hours and amounts of rescue analgesia administered will be recorded.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
64
After receiving general anesthesia, patients will positioned prone. Before operation begins, ESP block catheter will be applied with ultrasound guidance to the same level as surgeon's incision.
Perineural Injection
Izmir Bozyaka Training and Research Hospital
Karabağlar, İzmir, Turkey (Türkiye)
Dosage of Drugs
Amounts of drugs per kilogram per hour will be recorded
Time frame: During procedure
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded as reported by the patient according to NRS
Time frame: 30th minute postoperatively
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded as reported by the patient according to NRS
Time frame: 60th minute postoperatively
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded as reported by the patient according to NRS
Time frame: 2nd hour postoperatively
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded as reported by the patient according to NRS
Time frame: 6th hour postoperatively
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded as reported by the patient according to NRS
Time frame: 12th hour postoperatively
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded as reported by the patient according to NRS
Time frame: 24th hour postoperatively
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded as reported by the patient according to NRS
Time frame: 48th hour postoperatively
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded during the first steps as reported by the patient according to NRS
Time frame: Mobilisation at postoperative day (POD) 1
Post-operative pain assessed by Numeric Rating Scale (NRS)
Pain scores will be recorded during the procedure as reported by the patient according to NRS
Time frame: At the time of removal of nephrostomy at postoperative day (POD) 2
Opioid Consumption
Opioids(Tramadol) will be administered to patients in case demanded.
Time frame: 48 hour post-operatively
Discharge
Day of the discharge
Time frame: 240 hours post-operatively
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