Article ; Online: Erector spinae plane block with catheter for management of percutaneous nephrolithotomy: A three case report.
2020 Volume 99, Issue 40, Page(s) e22477
Abstract: Introduction: Percutaneous nephrolithotomy is a procedure used for management of refractory renal calculi. Oral and parenteral opioids, along with local anesthetic infiltration, neuraxial anesthesia, and paravertebral blocks are the most common methods ... ...
| Abstract | Introduction: Percutaneous nephrolithotomy is a procedure used for management of refractory renal calculi. Oral and parenteral opioids, along with local anesthetic infiltration, neuraxial anesthesia, and paravertebral blocks are the most common methods of managing intra-operative and post-operative pain for these patients. The erector spinae plane block with catheter (ESPC) is a newer interfascial regional anesthetic technique that can be used to manage peri-operative pain in these patients. Clinical findings: Three patients complained of significant flank pain were scheduled for percutaneous nephrolithotomy under general anesthesia in the prone position. Diagnoses: Patients were diagnosed with large renal calculi. Therapeutic interventions: Patients received ESPC in the pre-operative holding area at the level of the T7 transverse process. The ESPCS were bolused with a solution of 30 mL 0.25% bupivacaine with 4 mg dexamethasone prior to surgery. Patients also received oral tramadol 50 mg and acetaminophen 1 g as part of the multimodal pain protocol prior to surgery. After the procedure, the patients were bolused with 0.25% bupivacaine or started on an infusion of 0.25% bupivacaine to manage their pain. Outcomes: No opioid or other pain medications, other than the local anesthetic solution given in the ESPCs, were used during the intra-operative or post-operative period for management of pain in these patients. Visual analogue scale (VAS) scores were below 4 for all patients in the post-operative period, and patients did not report any issues with post-operative nausea or vomiting. Conclusion: These patients were compared to 3 prior patients who had undergone percutaneous nephrolithotomy without ESPC. The 3 patients without ESPC placement reported increased VAS scores, had increased opioid/pain medication consumption intraoperatively and postoperatively, and had increased incidence of perioperative nausea when compared to our ESPC patients. Our report shows that ESPC, in combination with a multimodal pain protocol, can be a good option for management of patients undergoing percutaneous nephrolithotomy. |
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| MeSH term(s) | Aged ; Anesthetics, Local/therapeutic use ; Bupivacaine/therapeutic use ; Dexamethasone/therapeutic use ; Female ; Humans ; Kidney Calculi/surgery ; Middle Aged ; Nephrolithotomy, Percutaneous/methods ; Nerve Block/methods ; Pain, Postoperative/prevention & control ; Paraspinal Muscles |
| Chemical Substances | Anesthetics, Local ; Dexamethasone (7S5I7G3JQL) ; Bupivacaine (Y8335394RO) |
| Language | English |
| Publishing date | 2020-10-23 |
| Publishing country | United States |
| Document type | Case Reports ; Journal Article |
| ZDB-ID | 80184-7 |
| ISSN | 1536-5964 ; 0025-7974 |
| ISSN (online) | 1536-5964 |
| ISSN | 0025-7974 |
| DOI | 10.1097/MD.0000000000022477 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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