The effects of single dose us guided erector spina plan block in percutan nephrolitotomy on postoperative pain and analgesic consumption

OBJECTİVE: We aimed to evaluate the effects of USG-assisted single dose ESPB on postoperative pain and analgesic consumption in percutaneous nephrolithotomy. Our primary outcome is the amount of opioid consumption in 24 hours, and our secondary outcomes are NRS scores, frequency of nausea, vomiting and itching, sedation scores, complications, length of hospital stay, patient and surgeon satisfaction, development of chronic pain. METHODS: Fiftysix patients aged 18-65 years old with ethics committee approval and patient consent, were included in this prospective, randomized, double-blind study. The patients were divided into 2 groups as Group ESBP and Group Control. USG guided ESPB (20ml / 0.25% bupivacaine) was applied to the patients before the anesthesia induction in Group ESPB and postoperative IVHKA containing morphine was applied. In Group Control, only IVHKA with morphine was applied. 1 gr paracetamol İV and morphine (0.07 mg/kg) administered to both groups 30 minutes before the end of the operation. Pain scores (NRS) at the 15th, 30th, 60th, 2nd, 6th, 12th, 24th hours postoperatively and morphine consumption, additional analgesic need, nausea-vomiting, itching, hospital stay, patient and surgeon satisfaction were recorded. Patients were questioned in terms of chronic pain at 3 months. RESULTS: The study was completed with 50 patients. NRS scores at 15. dk  2 (0-3) 4 (1,5-6,5)  (p<0,001 ), 30.dk  2 (0-3) 4 (3-5)  (p<0,001), 1st hr [2 (0-3.5) 4 (3-5.75)] (p<0.01), 2nd hr [0 (0-2) 3.5 (2-5)] (p<0.001), 6th hr [ 0 (0-2.5) 3 (2-4) ,75)] (p<0.001), 12th hr [ 0 (0-2) 2 (2-3)] (p<0.001), 24th hr [ 0 (0-1) 2 (2-2)] (p<0.001), statistically was significantly lower in Group E than group K (p<0.001). 24-hour morphine consumption, postoperative 15th min, [0 (0-0) 1 (0-1)] (p<0.001), 30th min, [0 (0-0) 1 (1-2)] (p< 0.001), 1st hr [ 0 (0-1.5) 3 (2-3)] (p<0.001), 2nd hr [ 1 (0-2) 4.5 (2.25-5)] (p<0.001) 0.001), 6th hr [ 2 (0-3) 8 (4.25-9)] (p<0.001), 12th hr [3 (0.5-6.5) 9.5 (7.25-) 15.5)] (p<0.001), 24th hrs [ 4 (1-7) 14.5 (10.5-21)] (p<0.001), was lower in Group ESPB compared to Group K (p=0.001). Nausea/vomiting frequency in Group K was found significantly higher than in Group E (p=0.02). Patient and surgeon satisfaction was higher in Group E (p<0.001), (p<0.01). There was no significant difference between the groups in hospital stay, sedation levels, complications and chronic pain (p>0.05). CONCLUSION: In our study, postoperative pain scores, total morphine consumption and frequency of nausea/vomiting were found lower in the Group ESPB compared to the Group Control, patient and surgeon satisfaction scores were higher in ESPB group. Chronic pain development was not observed in any patient. Key Words: Erector Spina Plan Block, Percutain Nephrolithotomy, Regional Anesthesia, Postoperative Pain