Erector spinae plane block versus thoracic paravertebral block in pediatric patients undergoing percutaneous nephrolithotomy: a prospective randomized clinical trial

TL;DR

This study compared two anesthesia techniques in children undergoing kidney stone surgery and found similar pain relief but faster block placement with one method.

Contribution

The study provides a direct comparison of ESPB and thoracic PVB in pediatric PCNL surgery, focusing on pain management and procedural efficiency.

Findings

ESPB and thoracic PVB showed similar time to first rescue analgesia and analgesic consumption.

ESPB placement was significantly faster than thoracic PVB.

Intraoperative hemodynamics and sevoflurane use were comparable between groups.

Abstract

Percutaneous Nephrolithotomy (PCNL) is a well-established surgical procedure for removal of large, multiple, and complex renal calculi in children. Combining loco-regional techniques with general anesthesia has gained increasing popularity in pediatric anesthesia. The objective of this trial was to evaluate the efficacy of Erector Spinae Plane Block (ESPB) versus thoracic Paravertebral Block (PVB) in pediatric patients undergoing PCNL procedure.

Fifty-six children, aged 2‒7 years, who underwent PCNL procedure under general anesthesia were randomly assigned to receive either ESPB (n = 28) or thoracic PVB (n = 28) with the same anesthetic mixture of 0.3 mL.kg-1 bupivacaine 0.25% in epinephrine 1:100000. The primary outcome was time to first rescue analgesia (nalbuphine).

The time to first rescue analgesia was 15.98 ± 10.17 hours (95% CI: 12.14–19.82) in the ESPB group versus 18.18 ± 9.18 hours (95% CI: 14.7–21.58) in the thoracic PVB group with no significant difference (p = 0.464, log-rank test). Moreover, the total dose and frequency of administration of nalbuphine during the first 24 postoperative hours were comparable between the two studied groups (p = 0.488 and 0.479 respectively). However, the time to conduct the block was significantly shorter in the ESPB group versus the thoracic PVB group (4.37 ± 1.08 minutes vs. 5.05 ± 1.17 minutes respectively, p = 0.028).

ESPB was not found to be more effective than thoracic PVB for postoperative pain management in children undergoing PCNL procedure. Moreover, intraoperative hemodynamics and maximum sevoflurane concentration were comparable. The time to conduct ESPB was significantly shorter; hence, it could be considered as an easy alternative to thoracic PVB for this procedure.

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