Analgesic Efficacy of Erector Spinae Block versus Quadratus Lumborum III Block in patients undergoing Unilateral Percutaneous Nephrolithotomy Surgery under General Anesthesia

This is a prospective observational study to be conducted on total of 78 patients of age between 18 to 65 years of either sex belonging to ASA grade I,II and III undergoing elective unilateral percutaneous nephrolithotomy surgery under general anaesthesia in All  India Institute of Medical Sciences, Bhopal after undergoing routine investigations and  pre anesthetic check up .An informed written consent will be obtained from patient and legally acceptable witness.Patient  will be randomly allocated to either group  E, receiving Erector spinae plane block :ESPB or group Q receiving quadratus lumbarm block III :QLB III through computer based allocater . In operation theatre all standard ASA monitoring will be attached and baseline vitals will be recorded including blood pressure ,ECG ,SpO2 , temperature. After induction of general anaesthesia and securing airway ,patient will be positioned according to block i .e. lateral position for QLB III and prone position for ESPB . Block will be performed after satisfactory placement of needle under ultrasound guidance and confirming by injecting 1- 2 ml of saline ,once confirmed 20 ml of inj. BUPIVACAINE 0.25% will be injected. Intraoperative hemodynamic monitoring will be done and Inj FENTANYL 1-2 mcg/kg  will be given if heart rate or blood pressure or both increases more than 20% of baseline. After the completion of surgery ,complete recovery from nesthesia and achieving adequate level of consciousness patient will be shifted to postoperative recovery room. Hemodynamic parameters will be monitored for 1 hour and patient will be shifted to ward .NRS scores will be assessed at interval of 1,2,6, 12 and 24 hours postoperative at rest and during activity. If NRS score is >= 3 injection paracetamol 1 gram will be given as rescue drug. If pain  persists then injection tramadol 50 mg slow i.v. infusion will be given as second analgesia . NRS scores will be furthers according to timeline and total total dose  of tramadol is calculated over 24 hours.Post operative complications will also be monitored.