Abstract
Context: Patients undergoing percutaneous nephrolithotomy (PCNL) experience considerable post-operative pain. Perioperative pain control for PCNL using regional anaesthesia techniques like erector spinae plane block (ESPB) helpsin better outcome in terms of pain, fentanyl requirement. It also indirectly helps in faster recovery and early discharge from hospital. Aims: To assess and compare perioperative pain control provided by ESPB with 0.5% bupivacaine and dexmedetomidine as adjuvant to it. Settings and Design: This randomized case control study was undertaken in a tertiary care centre. 60 patientsplanned for elective unilateral PCNL over a period of 15 months. Patients were randomized into two groups (Group B and group D) using envelope method. Patients were compared for fentanyl consumption, duration and effectiveness of analgesia obtained. Methods and Materials: ESPB was administered pre operatively under ultrasound guidance at the level of 10th thoracic vertebrae. Needle tip was visualised above transverse process of 10th thoracic vertebra. Position was confirmed by hydro dissection on injecting normal saline under ultrasound and drug was injected.Patients were assessed for painat specific time intervals. Total opioid consumption was noted. Data obtained was recorded and analysed. Statistical analysis used: Statistical analysis was performed by SPSS software v.23.0. Oneway analysis of variance, Bonferroni correction, Chi square test was used. P value of <0.05 was considered statistically significant. Results: Dexmedetomidine as adjuvant to local anaesthetic agent improves the quality and prolongs the duration of analgesia. It also decreases total fentanyl consumption. Conclusion: ESPB provides adequate analgesia for PCNL. Addition of dexmedetomidine decreases fentanyl and sevoflurane consumption meanwhile increasing duration of analgesia.
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