Publication:

Efficacy of ultrasound guided single level thoracic paravertebral block for post-operative analgesia in patients undergoing percutaneous nephrolithotomy: a randomized controlled study

Background Percutaneous nephrolithotomy (PCNL) is a common surgical method used for the treatment of renal calculi. Post-operative pain is due to dilatation of the renal capsule, the parenchymal tract and peritubal distressing of the nephrostomy tube. Addition of ultrasound guided paravertebral block to the multimodal postoperative analgesic regimen after general anaesthesia can achieve adequate somatic and visceral sensory blockade to provide post op analgesic cover for PCNL.

Methods It was a randomized controlled study where 60 ASA I and II patients scheduled for elective PCNL surgery were divided into 2 groups of 30 each, group P and group N. Both groups underwent PCNL under general anaesthesia. After the conclusion of surgery, group P were given ultrasound guided single level paravertebral block at T9-T10 level on the operated side using 10 ml 0.25% bupivacaine while group N did not receive paravertebral block after the conclusion of surgery.

Results VAS score, time for first rescue analgesic, number of rescue analgesics in post-operative period were significant in group P compared to group N.

Conclusions Addition of thoracic para vertebral block to multimodal analgesic regimen significantly provides effective analgesia, reduces requirements of intravenous opioids, maintains stable postoperative hemodynamics, improves respiratory mechanics and lowers the incidence of chronic postoperative pain.