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Fei M, Qin W, An G, Li D, Li C, Xiong L. Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study. Front Med (Lausanne) 2023; 10:1081530. [PMID: 36817763 PMCID: PMC9935603 DOI: 10.3389/fmed.2023.1081530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Background General anesthesia is used in the majority of patients undergoing percutaneous nephrolithotomy. To reduce the general anesthesia-related risks and complications, this study evaluated the efficacy and safety of the paravertebral block as a novel and alternative anesthetic method for percutaneous nephrolithotomy. Methods This was a retrospective study. A total of 198 patients under percutaneous nephrolithotomy were included. Among them, 76 patients received paravertebral block and 122 received general anesthesia. Patients' characteristics, surgical outcomes, anesthetic outcomes, and perioperative complications and the visual analog scale (VAS) were recorded to evaluate the efficacy and safety of paravertebral block compared with general anesthesia. Intergroup differences of the parameters were analyzed using an independent t-test and χ2-tests appropriate. Results Seventy-six patients who underwent paravertebral block completed the surgery successfully, three patients were supplemented with propofol for discomfort during ureteroscopy, and two patients were supplemented with remifentanil for incomplete nerve blockade. Patients who underwent paravertebral block had a higher American Society of Anesthesiologists grade and heart function grade, including patients with contraindications to general anesthesia. Intraoperative and postoperative adverse events and the anesthesia costs were less in patients who underwent paravertebral block. VAS pain scores during the postoperative period in patients who underwent paravertebral block were lower than those in patients who underwent general anesthesia without the use of patient-controlled intravenous analgesia. Conclusion In this retrospective study, paravertebral block was found to be effective and safe in providing intraoperative anesthesia for percutaneous nephrolithotomy, and had less adverse events and anesthesia costs. Paravertebral block is an attractive alternative anesthesia for patients at increased risk of comorbidities following general or neuraxial anesthesia.
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Affiliation(s)
- Miaomiao Fei
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Wendong Qin
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Guanghui An
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
| | - Dujian Li
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Cheng Li
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China,*Correspondence: Cheng Li,
| | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China,Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China,Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China,Lize Xiong, ,
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2
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Zhao Y, Kan Y, Huang X, Wu M, Luo W, Nie J. The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials. Front Surg 2022; 9:865362. [PMID: 35923436 PMCID: PMC9339658 DOI: 10.3389/fsurg.2022.865362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Paravertebral block (PVB) has been widely used in postoperative analgesia, especially in thoracic and breast surgery. However, the efficacy and safety of PVB for analgesia after renal surgery remains uncertain. Therefore, this study aimed to determine the postoperative analgesic efficacy and safety of PVB in renal surgery. Methods PubMed, Web of Science, Embase, and the Cochrane Library databases were systematically searched up to December 20, 2021. All randomized controlled trials (RCTs) evaluating the postoperative analgesic efficacy of PVB in renal surgery were collected. The meta-analysis was performed using RevMan 5.4 and Stata/MP 14.0 software. Results A total of 16 RCTs involving 907 patients were included in the meta-analysis. Ten studies investigated patients under percutaneous nephrolithotomy (PCNL), and six studies were done for patients under other renal surgery (nephrectomy or pyeloplasty). Compared with control groups (no block, sham block, or other nerve blocks), meta-analysis showed that PVB reduced 24-hour postoperative opioid consumption significantly (SMD = −0.99, 95%CI: −1.60–0.38, p = 0.001, I2 = 92%) and reduced pain scores at various time points within 24 h at rest and 1 h, 4 h, and 24 h at movement after renal surgery, furthermore, PVB prolonged the time to first postoperative analgesic requirement (SMD = 2.16, 95%CI: 0.94–3.39, p = 0.005, I2 = 96%) and reduced the incidence of postoperative additional analgesia (OR = 0.14, 95%CI: 0.06∼0.33, p < 0.00001, I2 = 50%). Subgroup analysis revealed that the postoperative analgesia effect of PVB was more significant in PCNL, and the use of bupivacaine for PVB seemed to have a better performance. Besides, there was no difference in the incidence of postoperative nausea, vomiting, and itching between PVB and control groups. Conclusion This study indicates that PVB may provide effective postoperative analgesia in patients under renal surgery, especially PCNL patients. Moreover, PVB is a safe analgesic method without significant analgesia-related complications.
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Affiliation(s)
- You Zhao
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
| | - Yanan Kan
- Department of Orthopedic, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xin Huang
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
| | - Ming Wu
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
| | - Weiping Luo
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
- Correspondence: Weiping Luo Jun Nie
| | - Jun Nie
- Department of Urology, People’s Hospital of Liyang City, Liyang, China
- Correspondence: Weiping Luo Jun Nie
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Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073625. [PMID: 33807296 PMCID: PMC8036507 DOI: 10.3390/ijerph18073625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022]
Abstract
Erector spinae plane block was recently introduced as an alternative to postoperative analgesia in surgical procedures including thoracoscopies and mastectomies. There are no clinical trials regarding erector spinae plane block in percutaneous nephrolithotomy. The aim of our study was to test the efficacy and safety of erector spinae plane block after percutaneous nephrolithotomy. We analyzed 68 patients, 34 of whom received erector spinae plane block. The average visual analogue scale score 24 h postoperatively was the primary endpoint. The secondary endpoints were nalbuphine consumption and the need for rescue analgesia. Safety measures included the mean arterial pressure, Ramsey scale score, and rate of nausea and vomiting. The visual analogue scale, blood pressure, and Ramsey scale were assessed simultaneously at 1, 2, 4, 6, 12, and 24 h postoperatively. The average visual analogue scale was 2.9 and 3 (p = 0.65) in groups 1 (experimental) and 2 (control), respectively. The visual analogue scale after 1 h postoperatively was significantly lower in the erector spinae plane block group (2.3 vs. 3.3; p = 0.01). The average nalbuphine consumption was the same in both groups (46 mL vs. 47.2 mL, p = 0.69). The need for rescue analgesia was insignificantly different in both groups (group 1, 29.4; group 2, 26.4%; p = 1). The mean arterial pressure was similar in both groups postoperatively (91.8 vs. 92.5 mmHg; p = 0.63). The rate of nausea and vomiting was insignificantly different between the groups (group 1, 17.6%; group 2, 14.7%; p = 1). The median Ramsey scale in all the measurements was two. Erector spinae plane block is an effective pain treatment after percutaneous nephrolithotomy but only for a very short postoperative period.
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4
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Yaman F, Tuglu D. Analgesic efficacy of ultrasound guided paravertebral block in percutaneous nephrolithotomy patients: a randomized controlled clinical study. BMC Anesthesiol 2020; 20:250. [PMID: 32993528 PMCID: PMC7523349 DOI: 10.1186/s12871-020-01169-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCN). Methods A total of 44 patients, falling in categories I to III of the American Society of Anesthesiologists, and aged between 18 and 65 years, who were scheduled for PCN, were randomly distributed into two groups. The anaesthetic intervention group (PVB) contained 22 individuals, who were injected at level T8-T9 with 20 mL 0.25% bupivacaine as a single administration. In the control group C, also containing 22 individuals, the intervention was not carried out. The groups were compared after PCN in terms of opioid use, pain score, opioid adverse effects profile and the need for supplemental analgesia. Results Visual analogue scale pain scores whilst at rest or moving were lower at the level of statistical significance in the PVB group compared to controls at 2 and 4 h post-surgery. At 6 and 8 h post-surgery, the control group had a lower VAS score when moving, and this result reached statistical significance (p < 0.05). The controls used more opioid relief than the PVB group and had lower scores for satisfaction (p < 0.05). Conclusion Ultrasound-guided PVB using bupivacaine and an in-plane technique provides effective analgesia in PNL. It is associated with high scores on patient satisfaction and minimal complications. Trial registration ClinicalTrials.gov, NCT04406012. Registered retrospectively, on 27 May 2020.
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Affiliation(s)
- Ferda Yaman
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Eskişehir Osmangazi, 26040, Eskişehir, Turkey.
| | - Devrim Tuglu
- Department of Urology, Faculty of Medicine, University of Kırıkkale, Kırıkkale, Turkey
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5
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Chen L, Ji J, Tian Y, Sun Q, Qiu X, Li X, Li B. Retrospective study of quadratus lumborum block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy. BMC Anesthesiol 2020; 20:217. [PMID: 32867683 PMCID: PMC7457541 DOI: 10.1186/s12871-020-01134-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background The postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL). Methods The medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment, respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery, respectively. The secondary observatory endpoints, including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia, were evaluated as well. Results The static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), itches, respiratory depression, the time for the first defecation, and the length of hospital stay (LOS) among the three groups. Conclusions QLB-L procedure may exert as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL procedure.
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Affiliation(s)
- Luning Chen
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Jingjing Ji
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Yali Tian
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Qing Sun
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xuefeng Qiu
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xiaogong Li
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Bingbing Li
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China.
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6
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Analgesic efficacy of erector spinae plane block in percutaneous nephrolithotomy. Anaesthesist 2019; 68:755-761. [DOI: 10.1007/s00101-019-00673-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
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7
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Yeying G, Liyong Y, Yuebo C, Yu Z, Guangao Y, Weihu M, Liujun Z. Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures. J Int Med Res 2017. [PMID: 28635359 PMCID: PMC5805206 DOI: 10.1177/0300060517710068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management
and preservation of pulmonary function compared with intravenous,
patient-controlled analgesia (IVPCA) in patients with multiple rib fractures
(MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study
and randomly assigned to the TPVB or IVPCA group. The visual analogue scale
(VAS) pain score, blood gas analysis, and bedside spirometry were measured
and recorded at different time points after analgesia. Results TPVB and IVPCA provided good pain relief. VAS scores were significantly lower
in the TPVB group than in the IVPCA group at rest and during coughing
(P < 0.05). Patients in the TPVB group had a higher
PaO2 and PaO2/FiO2 and lower
P(A–a)O2 compared with the IVPCA group
(P < 0.05). Moreover, patients in the TPVB group
showed higher FVC, FEV1/FVC, and PEFR, and fewer complications than did the
IVPCA group (P < 0.05). Conclusion TPVB is superior to IVPCA in pain relief and preservation of pulmonary
function in patients with MRFs.
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Affiliation(s)
- Ge Yeying
- 1 Department of Anesthesiology, Ningbo 6th Hospital, Ningbo 315040, China
| | - Yuan Liyong
- 1 Department of Anesthesiology, Ningbo 6th Hospital, Ningbo 315040, China
| | - Chen Yuebo
- 1 Department of Anesthesiology, Ningbo 6th Hospital, Ningbo 315040, China
| | - Zhang Yu
- 1 Department of Anesthesiology, Ningbo 6th Hospital, Ningbo 315040, China
| | - Ye Guangao
- 1 Department of Anesthesiology, Ningbo 6th Hospital, Ningbo 315040, China
| | - Ma Weihu
- 2 Department of Orthopeadic Surgery, Ningbo 6th Hospital, Ningbo 315040, China
| | - Zhao Liujun
- 2 Department of Orthopeadic Surgery, Ningbo 6th Hospital, Ningbo 315040, China
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