Thoracic Paravertebral Block versus Epidural Anesthesia Combined with Moderate Sedation for Percutaneous Nephrolithotomy

Abstract

Objective: To investigate the feasibility of thoracic paravertebral block (TPVB) for percutaneous nephrolithotomy (PCNL) in comparison with epidural anesthesia (EA) combined with moderate sedation. Subjects and Methods: One hundred American Society of Anesthesiologists (ASA) I-II adult patients scheduled for first-stage unilateral PCNL were randomly assigned to receive either TPVB or EA. All patients were given standard sedation and analgesia with propofol and sufentanil. Patient characteristics, surgical outcomes, anesthetic outcomes, and time to first use of a patient-controlled intravenous analgesic (PCIA) device and postoperative consumption of sufentanil in the first 24 h were recorded. Intergroup differences of the parameters were analyzed using an independent t test, Mann-Whitney test, and χ² test as appropriate. Results: Patients who received TPVB consumed more propofol during ureteroscopy (56.2 ± 28.4 vs. 42.9 ± 27.5 mg, p < 0.05) and more sufentanil during ureteroscopy (9.7 ± 4.8 vs. 3.9 ± 2.7 μg, p < 0.05) and during PCNL (7.0 ± 4.3 vs. 1.9 ± 1.8 μg, p < 0.05) than those who received EA. The volume fluids infused in patients who received TPVB was less than in those who received EA (854 ± 362 vs. 1,320 ± 468 ml, p < 0.05). Time to first PCIA use, postoperative 24-hour consumption of sufentanil, and other parameters were comparable between groups. Conclusions: In this study, TPVB was as effective and safe as EA in providing intraoperative anesthesia and postoperative analgesia for PCNL, although more sedatives and analgesics were used during PCNL in patients who received TPVB.

Usage of Multilevel Paravertebral Block as the Main Anesthesia for Mini-Invasive PCNL: Retrospective Review of 45 Cases with Large Stones

“…As highly localized pain management, PVB is widely used for postoperative analgesia or assistance to GA for PCNL [14,15] . To our knowledge, only 2 trials evaluated the efficiency of PVB as the single main anesthesia method for PCNL, while the results were promising [16,17] . In Kamble's study, 0.5% bupivacaine combined with 1 μg/kg clonidine was used in single-level PVB, which was useful, effective, and safe for intra as well as postoperative analgesia for PCNL procedures [17] .…”

“…In Kamble's study, 0.5% bupivacaine combined with 1 μg/kg clonidine was used in single-level PVB, which was useful, effective, and safe for intra as well as postoperative analgesia for PCNL procedures [17] . Li et al [16] compared PVB with EA, the results showed that PVB was as effective and safe as EA for PCNL. In our study, there were 4 patients with ASA score III, who could not receive normal GA.…”

“…Different from former reports [14,16] , in this study, multiple segment injections were applied instead of a single-level injection for PVB. Normally, to relieve renal pain, a block over T10 to L1 segments was needed [18] .…”

“…On the other hand, bilateral paravertebral injections rather than one-sided multiple injections are likely to significantly increase the incidence of complications or failure [20] . In some studies, anesthetists preferred to insert a catheter into the paravertebral lumen, for the purpose of continuous blocking and prolonged postoperative analgesic [14,16,17] . However, regardless of continuous or single dose, only single-level blocking could not meet the requirement of PCNL procedure, which needed more intravenous sedatives and analgesics [16] .…”

“…In some studies, anesthetists preferred to insert a catheter into the paravertebral lumen, for the purpose of continuous blocking and prolonged postoperative analgesic [14,16,17] . However, regardless of continuous or single dose, only single-level blocking could not meet the requirement of PCNL procedure, which needed more intravenous sedatives and analgesics [16] . According to our experience, enough blocked segments involving surgical region is more important than continuity of drugs to ensure the anesthesia effective.…”