الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Renal surgeries are usually associated with postoperative pain, nausea, and vomiting. Good perioperative pain management is very important as acute postoperative pain after PCNL is an important risk factor for development of chronic postoperative pain.
Current management of post PCNL pain emphasizes regional anesthesia techniques due to their efficacy and reduced side effects compared to opioids.
Opioids are primarily used for initial and breakthrough pain management after PCNL, but their use is limited due to potential complications like sedation, nausea, vomiting, and respiratory depression.
Thoracic epidural analgesia and paravertebral block associated with rare but serious risks like pneumothorax and total spinal anesthesia, have become the preferred techniques for superior pain control.
The advent of ultrasound guidance in regional anesthesia has facilitated the development of various novel nerve blocks offering effective analgesia for renal surgery with a more favorable side-effect profile compared to opioids.
Forero et al., were the first to describe ESPB as a new analgesic technique to treat post thoracotomy neuropathic pain and now it is used for many different indications.
The Erector Spinae Plane Block (ESPB), a novel regional anesthetic technique, injects local anesthetic (LA) under ultrasound guidance between the erector spinae muscle (ESM) and transverse process (TP). This targets the dorsal and ventral rami of the thoracic and abdominal spinal nerves for pain relief. Cadaver studies using radiological imaging suggest a single ESPB injection at the T9 level can spread extensively, reaching from the thoracic vertebrae (T5) to the lumber vertebrae (L1). This spread explains the broad sensory block observed in case reports, potentially matching the effectiveness of the established paravertebral block (PVB).
The aim of the current study was to compare the efficacy of the US guided PVB and the ESPB in decreasing the intensity of postoperative pain using VAS following PCNL.
After approval of the Ethics Committee of the Faculty of Medicine - Alexandria University and a written consent from each patient, a sample size of 40 patients (20 for each group) underwent PCNL under GA at the Urology department - Alexandria Main University hospital were enrolled in the study. This sample size was according to the recommendation of the Department of Statistics, Medical Research Institute, Alexandria University. The patients were randomly divided into two equal groups using closed envelope method.
All patients were informed of the procedure and trained to use VAS to express their pain.
All patients arrived to the block area before the operation by 30 minutes where the blocks were carried out. A multichannel monitor for vital signs monitoring was attached. All patients were sedated via midazolam (0.02 mg/kg) as a premedication.
Either PVB or ESPB was performed under complete aseptic technique. Each group received 20 ml of 0.5% bupivacaine injected at the level of T9. After establishing that the block was effective, patients were transferred to the OR, and GA was induced.