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.