The effects of anterior quadratus lumborum block and erector spina plan block on post-operative acute pain in percutaneous nephrolithotomy surgery

Objectives: Percutaneous nephrolithotomy (PNL) is an increasingly popular current therapeutic approach for the treatment of kidney stones. Although PNL is a minimally invasive procedure, significant pain is associated with the surgery. With the introduction of ultrasound into regional anesthesia practice, new trunk blocks have become a part of multimodal analgesia. The aim of our study was to investigate the effect of anterior quadratus lumborum block (QLB3) and erector spina plan block (ESPB) on postoperative cumulative morphine consumption in patients undergoing PNL surgery. Hyposet of the thesis: There is a significant difference in cumulative morphine consumption in the first 24 hours postoperatively between QLB3-ESPB-control groups in patients undergoing PNL surgery. Materials and Methods: In our study, which was planned according to a prospective, observational cohort design, 90 patients aged 18-65 years with ASA (AmericanSociety of Anesthesiologist) I-III risk score who were planned for elective PNL surgery were included after approval of Ondokuz Mayıs University Clinical Research and Faculty Ethics Committee. Patients were divided into three groups of 30 patients: group QLB3, group ESPB and control group. ESPB was administered in addition to multimodal analgesia in the ESPB group and QLB3 in the QLB3 group. Patients were followed up with a patient-controlled analgesia device for the first 24 hours postoperatively. In addition to opioid consumption in the first 24 hours, pain (at rest and activity) and nausea-vomiting scores, intraoperative remifentanil consumption, time to first morphine request from patient-controlled analgesia, need for rescue analgesia, hemodynamic parameters and complications were recorded in the postoperative period. Results: The total amount of morphine consumed in the first 24 hours postoperatively in the QLB3 and ESPB groups was significantly lower than in the control group (p< 0,001). There was no significant difference between the ESPB group and the QLB3 group. While the demographic data, hemodynamic parameters, and incidence of postoperative nausea-vomiting were similar in the groups, the resting and activity NRS scores of the patients were significantly lower in the QLB3 and ESPB groups than in the control group at 0.hour, 3.hour, 6.hour, and 12.hour (p<0.001). There was no difference between the QLB3 group and the ESPB group. Intraoperative remifentanil consumption was significantly higher in the control group than in the QLB3 and ESPB groups (p<0.001), while there was no statistically significant difference between the ESPB group and the QLB3 group in terms of intraoperative remifentanil consumption. In terms of the first morphine request time from the postoperative PCA, although there was a prolongation in the request time in the QLB3 and ESPB group compared to the control group, this prolongation did not result in a statistically significant difference. No block or drug-related complications were observed. Conclusion: PNL surgery, total morphine consumption in the first 24 hours postoperatively was found to be similar in ESPB and QLB3 groups and lower in the control group. Keywords: Percutaneous Nephrolithotomy; Postoperative Pain; Patient Controlled Analgesia; Acute Pain; Ultrasonography; Nerve Block