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

Abstract

Introduction: To evaluate the efficiency and safety of the paravertebral block (PVB) as the single main anesthesia for unilateral mini-invasive percutaneous nephrolithotomy (PCNL). Materials and Methods: Forty-five American Society of Anesthesiologists grade I/II/III patients with large upper urinary tract stones were included in our retrospective study. All patients received multilevel PVB from T10 to L1 with 10 mL of 0.5% ropivacaine for each segment. After the block was confirmed, unilateral mini-invasive PCNL was performed. Intraoperative and postoperative pain management and associated adverse events were observed to investigate the feasibility of PVB in mini-invasive PCNL as the main anesthesia. Results: Successful blocking was confirmed 20 min after paravertebral injections. The mean operation time was 59 min. None of the patients experienced severe pain or hemodynamic dysfunction. Stone-free rate was 93.1% and no blood transfusion was required. The mean time to first analgesic requirement was 160 min, and the mean consumption of diclofenac sodium suppositories was 150 mg. All patients contained normal muscle strength on the contralateral side. Patients could recover ambulation within 1 h after the operation. Conclusions: Multilevel PVB was proved to be suitable as the main anesthesia for unilateral mini-invasive PCNL, providing feasible pain relief and quick postoperative recovery.

Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study

“…The tract to block for lithotripsy typically includes the 10th and 11th intercostal spaces (31). Sensory nerves in this area are readily anesthetized by a thoracic paravertebral block, while kidney and ureter nerves originate from T 10 to L 1 (13,25). In contrast to previous reports (26), we observed that blocking the homolateral spinal nerves from T 8 to L 1 led to satisfying sensation reduction and provided effective anesthesia for percutaneous nephrolithotomy.…”

“…There are several reports on the use of paravertebral block for percutaneous nephrolithotomy, though it is mainly used for intraand postoperative analgesia (13,(21)(22)(23). Mei et al presented reports to share their experience with paravertebral block as the main anesthesia used for percutaneous nephrolithotomy (24,25). Other studies compared paravertebral block combined with moderate sedation with intraspinal anesthesia for percutaneous nephrolithotomy (26).…”

Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts—An innovative ambulatory surgery mode

“…It has many advantages, such as a lower dosage of anesthetic, more stable hemodynamics, and improved pulmonary function, due to localized nerve blocking within the paravertebral space [ 12 ]. Recently, with careful planning and use of ultrasound guidance, PVB has achieved adequate somatic and visceral sensory blockade to meet the anesthetic needs for percutaneous nephrolithotomy (PCNL) in our center [ 13 , 14 ].…”

Successful Percutaneous Nephrolithotomy Using Thoracic Paravertebral Block as the Sole Surgical Anesthesia: Cases Report

“…6,7 A previous study showed that multilevel TPVB from T10 to L1 was feasible in PCNL surgery. 8 This study performed multiple TPVBs at each segment of the vertebrae (T10, T11 and T12), using a conventional technique. An ultrasound scan was only used to locate the transverse process of the spine, and then the loss of resistance technique was applied.…”

“…An ultrasound scan was only used to locate the transverse process of the spine, and then the loss of resistance technique was applied. 8 However, there are no published reports using real-time multi-segment ultrasound guidance at alternating levels for TPVB as the main surgical anesthesia in PCNL surgery. Therefore, we performed multilevel TPVB at alternating segments (i.e.…”