AUTHOR=Zhu Pengcheng , Meng Qianqian , Miao YuanYuan , Zhou Le , Wang Chun , Yang Haitao 

TITLE=Paravertebral block vs. epidural block for percutaneous nephrolithotomy: A prospective, randomized study

JOURNAL=Frontiers in Surgery

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1112642

DOI=10.3389/fsurg.2023.1112642

ISSN=2296-875X

ABSTRACT=<sec><title>Background</title><p>Percutaneous nephrolithotripsy (PCNL) is the main method for urinary calculi. An anesthesia method with little effect on the blood circulation and which does not affect the postoperative activity of a patient is lacking.</p></sec><sec><title>Objective</title><p>To compare the effects of paravertebral nerve block (PNB) and epidural block (EPB) on quadriceps femoris muscle (QFM) strength in patients after PCNL.</p></sec><sec><title>Methods</title><p>163 patients were separated into two groups: EPB (81) and PNB (82). Primary outcome parameters were QFM strength and range of motion (RoM) of the knee 1 h, 2 h, 3 h, and 24 h after anesthesia induction (AI). Secondary outcome parameters were: time from AI beginning to first ambulation; time of sensory-plane recovery; amount of additional analgesics given during and after surgery; prevalence of nausea and vomiting; duration of hospital stay (DoHS); mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO<sub>2</sub>) before, 0.5 h, and 1 h after AI; visual analog scale (VAS) score 0.5 h, 1 h, 2 h, 3 h and 24 h after AI.</p></sec><sec><title>Results</title><p>There was no significant difference in QFM strength or knee RoM before or 24 h after AI between the two groups (<italic>P</italic> &gt; 0.05). The time from AI to first ambulation was shorter (<italic>P</italic> &lt; 0.05) and the sensory plane took longer to recover (<italic>P</italic> &lt; 0.05) in the PNB group than in the EPB group. The amount of additional analgesics during surgery was more in the PNB group than in the EPB group (<italic>P</italic> &lt; 0.05), but there was no significant difference after surgery (<italic>P</italic> &gt; 0.05). VAS scores were higher in the PNB group than in the EPB group 0.5 after AI (<italic>P</italic> &lt; 0.05). MAP 1 h after AI was higher in the PNB group than in the EPB group (<italic>P</italic> &lt; 0.05). There was no significant difference in the prevalence of postoperative nausea and vomiting, DoHS, HR, or SpO<sub>2</sub> at 0.5 h and 1 h after AI between the two groups (<italic>P</italic> &gt; 0.05).</p></sec><sec><title>Conclusions</title><p>For patients undergoing PCNL, PNB can meet the need for surgical analgesia while having little effect on QFM strength.</p></sec><sec><title>Trial registration</title><p><ext-link ext-link-type="uri" xlink:href="http://www.chictr.org.cn/" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.chictr.org.cn/</ext-link>, identifier ChiCTR2200060606.</p></sec>