Paravertebral block for percutaneous nephrolithotomy: a prospective, randomized, double-blind placebo-controlled study
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ORIGINAL ARTICLE
Paravertebral block for percutaneous nephrolithotomy: a prospective, randomized, double‑blind placebo‑controlled study Kristin G. Baldea1 · Parth M. Patel1 · Grace Delos Santos1 · Chandy Ellimoottil2 · Ahmer Farooq1 · Elizabeth R. Mueller1 · Scott Byram3 · Thomas M. T. Turk1 Received: 2 August 2019 / Accepted: 10 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Percutaneous nephrolithotomy (PCNL) is performed commonly in patients with large kidney stones, but the management of their postoperative pain presents a major challenge. While it is not routinely performed in PCNL patients, paravertebral block (PVB) has been described as an effective strategy for pain control after various non-urologic surgeries. This trial aims to assess the effect of paravertebral blockade on intraoperative and postoperative opioid use as well as postoperative pain control in patients undergoing PCNL. Methods This was a prospective, randomized, double-blind, placebo-controlled study. Patients who consented to participate were randomly assigned to undergo either PVB or a placebo intervention preoperatively. The patient, surgeon, and anesthesia team were all blinded to the randomization. The outcome parameters were intraoperative opioid requirement, postoperative visual analog scale (VAS) pain scores, postoperative opioid use, and postoperative antiemetic use. Results 23 patients were enrolled in each arm of the study, and the two groups had no significant differences in baseline demographic or clinical characteristics. Patients in the PVB group had significantly lower intraoperative opioid use, postoperative opioid use, frequency of opioid use, and antiemetic. Patients in the PVB group also had lower postoperative VAS pain scores. There were no patients who suffered from complications attributable to PVB. Conclusion The results of this randomized, double-blind, placebo-controlled trial suggest that PVB should be considered an effective strategy to reduce opioid requirement and improve pain control for patients undergoing PCNL. Keywords Nephrolithiasis · Percutaneous nephrolithotomy · Pain management · Paravertebral · Nerve block
Introduction Nephrolithiasis affects millions of Americans each year. In the year 2000, there were over 2 million outpatient visits for kidney stones with a total estimated annual expenditure
of $2.1 billion [1]. There are a variety of strategies used to manage nephrolithiasis including medical expulsive therapy, extracorporeal shock wave, ureteroscopy, open surgery and percutaneous nephrolithotomy (PCNL). PCNL is favored over other forms of kidney stone management especially
* Parth M. Patel [email protected]
Scott Byram [email protected]
Kristin G. Baldea [email protected]
Thomas M. T. Turk [email protected]
Grace Delos Santos [email protected]
1
Chandy Ellimoottil [email protected]
Department of Urology, Loyola University Medical Center, Maywood, IL 60153, USA
2
Ahmer Farooq [email protected]
Department of Urology, U
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