Login to Access Video or Poster Abstract: MP75-01
Sources of Funding: None

Introduction

Percutaneous nephrolithotomy (PCNL) is considered the gold standard minimally invasive treatment for large stone burdens, but post-operative pain control remains challenging. Paravertebral block (PVB) has been described for breast and thoracic surgery as an effective pain control strategy, but is not being utilized for PCNL. The objective of this study was to evaluate the effect of paravertebral block on pain control and opioid use following PCNL.

Methods

This was a prospective, randomized, double-blind, placebo-controlled study. Willing patients undergoing unilateral PCNL for stone disease were consented and randomized to receive either PVB or placebo intervention in the preoperative area. The PVB consists of a single injection of 20 mL of 0.5% bupivacaine into the T10 paravertebral space under ultrasound guidance. For the placebo intervention, the ultrasound probe is applied, the skin is infiltrated with lidocaine, and pressure is held to mimic injection. The patient, surgeon, and anesthesia team were blinded to the study group. Patients received patient-controlled analgesia (PCA) following surgery. Outcomes were visual analog scale (VAS) pain scores, intra-operative and post-operative opioid use, and anti-emetic use. Statistical analysis was performed using paired t-tests for continuous variables and chi-square tests for categorical variables.

Results

The 45 patients enrolled in the study had no difference in baseline characteristics. There were no complications attributed to the PVB. The average VAS pain score was lower in the PVB group. Intra-operative opioid use, post-operative opioid use, frequency of opioid use, and anti-emetic use were significantly lower in the PVB group as compared to the control group. The time from the conclusion of surgery to the first administration of opioids was longer in the PVB group

Conclusions

To our knowledge, this is the first randomized, double-blind, placebo-controlled trial investigating the use of PVB in PCNL. PVB prior to PCNL improved average VAS pain scores and decreased both intra-operative and post-operative opioid use. The reduction in opioid use likely leads to improved nausea as reflected in decreased anti-emetic use. PVB should be considered an effective strategy to reduce pain for patients undergoing PCNL.

Funding

None