Comparison of ultrasound guided single level paravertebral block with peritubal infiltration for postoperative analgesia in patients undergoing percutaneous nephrolithotomy.

This randomized comparative study aims to evaluate the postoperative analgesic efficacy of ultrasound-guided single-level thoracic paravertebral block (PVB) versus peritubal infiltration (PTI) in patients undergoing percutaneous nephrolithotomy (PCNL) under general anesthesia. PCNL, although minimally invasive, is often associated with moderate to severe postoperative pain due to renal capsular stretch, pelvicalyceal system distension, and nephrostomy tube irritation. Effective pain control is crucial to enhance recovery and reduce opioid-related side effects.

A total of 30 adult patients (aged 18–65 years) with ASA I–II undergoing elective PCNL will be enrolled and randomized into two equal groups. Group PV will receive a single-level ultrasound-guided PVB at the T8–T9 level with 20 mL of 0.25% bupivacaine. Group PT will receive four-quadrant peritubal infiltration with the same volume and concentration of bupivacaine under fluoroscopic guidance. All patients will receive standard general anesthesia and postoperative monitoring.

The primary outcome is total tramadol consumption in the first 24 hours postoperatively. Secondary outcomes include pain scores using the Numerical Rating Scale (NRS) at multiple time points, time to first rescue analgesia, hemodynamic parameters, block administration time, and any complications.

This study seeks to identify which of the two regional analgesia techniques provides superior pain control with minimal side effects, potentially optimizing postoperative care in PCNL patients.