The comparison of ultrasound guided low thoracic paravertebral block versus peritubal infilration in percutaneous nephrolithotomy

Purpose: Our aim in this paper is to examine the effects of bupivacaine, peritubal infiltration and low thoracic paravertebral block to postoperative opioid consumption of patients to whom percutaneous nephrolithotomy (PCNL)is implemented. Material and Method: After ethical board approval, 60 patients who are planned to be operated by the urology clinic under elective unilateral PCNL, are classified as 1 and 2 risk levels in ASA pre anesthetic evaluation and are between ages 18-60 were included in our study after their conformation of voluntariness. Patients are diveded to three groups. Same anesthetic protocol is applied to each group. Group Peritubal Infiltration (n=20): After the surgical operation, infiltration was applied with 20 ml 0.25 % bupivacaine through renal capsule, muscle, subcutaneous tissue and skin in prone position. Group Paravertebral Block (n=20): After the surgical operation, paravertebral block was applied by in-plane technique in T8-T9 levels with 20 ml 0.25 % bupivacaine and USG in prone position. Control group (n=20): No intervention. Intravenous PCA was used to generate postoperative analgesia. Postoperative patient follow-up and evaluation was carried out by a researcher that had no information about the research group. Results: There were no difference in demographic data and surgery and anesthetic times of the groups. Postoperative fentanyl consumption in 0-4 hours was significantly less in paravertebral block group than in control group and peritubal infiltration group (p<0.05). Postoperative fentanyl consumption in 0-4 hours was significantly less in peritubal infiltration group than in control group (p<0.05). In 4-8 and 8-24 hours there were no significant difference in fentanyl consumption amount between peritubal infiltration group and control group (p>0.05) whereas in paravertebral block group fentanyl consumption amount was significantly less than in control group (p<0.05). Total fentanyl consumption in 24 hours was significantly less in paravertebral block group and peritubal infiltration group than in control group whereas it was significantly less in paravertebral block group than in peritubal infiltration group (p<0.05). VAS scores were evaluated in rest and active motion (cough and deep breath). There were no significant differences between paravertebral block group and peritubal infiltration group in rest VAS scores (p>0.05). In 8 patients in control group, in 2 patients in peritubal infiltration group and in 1 patient in paravertebral block group additional analgesia was needed and there were significant differences (p<0.05). Conclusion: In this research we determined that in PCNL, paravertebral block decreases postoperative opioid consumption and provides more efficient analgesia than peritubal infiltration. Peritubal infiltration is easy to implement, cost-effective and provides efficient analgesia in especially early postoperative period.