INTRODUCTION
Percutaneous Nephrolithotomy (PCNL) is currently the most frequently
preferred minimally invasive surgical procedure in the treatment of
kidney stones. It is accepted as the first-line treatment for many
kidney stones >2 cm, staghorn calculi, or when other
methods of management fail 1.
Although PNL is performed as a minimally invasive procedure, it causes
severe postoperative pain due to dilatation of the renal capsule and
parenchymal canal and peritubal distension of the nephrostomy tube2. Effective treatment of postoperative pain allows
early mobilization of the patient, shortens the recovery and discharge
time, prevents the development of chronic pain, increases satisfaction
and long-term quality of life3.
Pain related to the PCNL may cause nausea and vomiting, and aggressive
management with opioids alone can result in respiratory depression4. Tramadol is a weak opioid used for postoperative
pain relief without causing the respiratory depression seen with other
opioids. It has common side effects such as nausea and vomiting and may
be insufficient in postoperative analgesia 5. Poor
postoperative pain management increases the risk of postoperative
pulmonary complications (PPC). In patients undergoing percutaneous
nephrolithotomy, the decrease in inspiratory and vital capacity due to
the close proximity of the operation to the diaphragm increases the risk
of atelectasis 6. In addition, unsuccessful pain
management can cause postoperative delirium and agitation7.
ESPB is a periparavertebral regional anesthesia technique applied for
the first time in the treatment of thoracic neuropathic
pain8. ESPB, which is an easily applicable block with
low complication rate, has been shown to be effective in postoperative
pain management of PCNL in the literature 9-14.
We aimed to investigate the effectiveness of ESPB in postoperative pain
management of patients who underwent percutaneous nephrolithotomy
operation and to demonstrate the positive outcomes of pain management if
there is by recording serial peak expiratory flow rate (PEFR)
measurements, the patient’s postoperative agitation score (Riker
sedation-agitation scale), time to mobilize, and length of hospital
stay.