Erector spinae plane block for postoperative analgesia following percutaneous nephrolithotomy: A randomized controlled study

Percutaneous nephrolithotomy (PCNL) is currently thefrequently employed surgical procedure for the removal of large complex renaland proximal ureteric calculi. Being minimally invasive it hasless morbidity, and allows early recovery and ambulation after surgery. Postoperativepain following PCNL has both visceral and somatic components. Visceralcomponent arises from the kidney, renal capsule and ureter, while the somaticcomponent from the skin incision and the nephrostomy tract. The nephrostomy tube that is inserted at the end of the procedure can elicitinflammatory reaction leading to pain and discomfort.

Although PCNL is a minimally invasive procedure,postoperative pain can be severe and inadequate postoperative analgesia is abarrier to early recovery after surgery. Systemic analgesics like opioids,non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol form themainstay for providing pain relief. However, opioids are associated with sideeffects like nausea, vomiting, pruritus, constipation, and respiratorydepression, while NSAIDs may be relatively contraindicated in these patientswho may have compromised renal function.

Regional anaesthetic techniques like intercostalnerve block, paravertebral block, epidural analgesia, peritubal infiltrationand subcutaneous infiltration have been employed for providing postoperativeanalgesia following PCNL.Erector spinae plane [ESP] block is arecently described interfascial  planeblock for providing postoperative analgesia following thoracic and abdominalsurgeries.Its use for providing pain relief following PCNL isrecently been described in literature,  However , there is paucityof literature providing its efficacy following PCNL surgery. Hence, the presentstudy is designed to evaluate its role in providing postoperative analgesiafollowing PCNL.