Efficacy of erector spinae plane block in relieving the post operative pain of patients undergoing percutaneous nephrolithotomy

Phase 3

Not yet recruiting

Brief Summary: Ultrasound guided erector spinae plane (ESP) block is a regional anaesthesia technique, recently described by Forero et al for use in thoracic neuropathic pain. In ESP block, the local anaesthetic is injected, using ultrasound guidance, deep to erector spinae muscle group and superficial to a thoracic transverse process, resulting in extensive deep and superficial spread that lead to analgesic effect on somatic and visceral pain by effecting the ventral rami and rami communicants that include sympathetic nerve fibres, as LA spreads through the paravertebral space. When performed bilaterally it has been reported to be as effective as thoracic epidural analgesia.

Besides the anecdotal case reports regarding the use of erector spinae plane block in various situations, the review of literature could not disclose any randomised control trial with respect to ESPB in PCNL. Hence the present study has been designed to evaluate the efficacy of erector spinae plane block in providing post- operative analgesia to patient undergoing PCNL in comparison to well established technique of IV PCA.

In the proposed study, ESPB will be performed at the level of T12 in prone position post operatively before extubation of patient, in interventional group, who underwent PCNL. Post extubation patient will be attached to IVPCA morphine pump. VAS score will be used as tool to assess the severity of pain.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

History of relevant drug allergy 2.
Patient refusal 3.
History of psychiatric illness, substance abuse or medical therapies resulting in tolerance to opioids 4.Severe cardiovascular, respiratory, metabolic or neurologic disease.
Pregnancy 6.
Untreated sepsis 7.
Local infection 8.
Severe coagulopathy (PTI<70% / INR>1.5) 9.
Complex stone with anticipation of requiring >1 access site.
Prior diagnosis of chronic pain requiring daily opioid analgesic for >1 month prior to diagnosis of nephrolithiasis.
Back or other musculoskeletal deformity that contributes to inaccuracy of the block placement.
Fibromyalgia.

Primary Outcome Measures

Name	Time	Method
To evaluate the reduction in pain intensity up to 24 hours in post-operative period by the use of visual analogue scale in patients receiving erector spinae plane block after percutaneous nephrolithotomy.	10 mins, 30 mins, 1hr, 4hrs, 8 hrs, 12hrs, 24hrs

Secondary Outcome Measures

Name	Time	Method
To calculate and compare the total opioid consumption over 24 hours in erector spinae plane block group as well as control group	24 hrs
To calculate and compare the total dose of antiemetics over 24 in erector spinae plane block group as well as control group	10 mins, 30 mins, 1hr, 4hr, 8hr, 12hr, 24hr
To note any side effects pertaining to the procedure or the drugs used in the present study	10 mins, 30 mins, 1hr, 4hrs, 8hrs, 12hrs, 24hrs

Locations (1): Government Medical College Hospital, Chandigarh
🇮🇳
Chandigarh, CHANDIGARH, India
Government Medical College Hospital, Chandigarh
🇮🇳Chandigarh, CHANDIGARH, India
Arush Singla
Principal investigator
7009947996
arush2k12@gmail.com