Perioperative Analgesic Effects of Preemptive Ultrasound-Guided Subcostal Transversus Abdominis Plane Block for Percutaneous Nephrolithotomy: A Prospective, Randomized Trial

Abstract

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing kidney stones, but patients still suffer from moderate postoperative pain. The aim of this study is to evaluate the perioperative analgesic effect of ultrasound-guided subcostal transversus abdominis plane (TAP) block performed before PCNL procedure. Materials and Methods: Patients scheduled for elective PCNL were randomized into two groups: Group TAP and Group IV. General anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane, fentanyl, and rocuronium. Unilateral ultrasound-guided TAP block was performed with total of 30 mL volume of local anesthetic solution (20 mL bupivacaine 0.125% plus 10 mL lidocaine 1%) after intubation but before surgery to the Group TAP patients. Paracetamol 1 g was given to the Group IV. Tramadol 100 mg and morphine IV-patient-controlled analgesia were applied to both groups. Perioperative fentanyl consumption, postoperative verbal analog scale (VAS), morphine consumption, and additional analgesic drug requirement were assessed. Chi square with Yates correction and Mann-Whitney U tests were used for statistical analysis. Results: Eighty patients were assessed for enrollment. One patient developed septicemia at the recovery room so data of 79 patients were collected for statistical analysis. Total morphine consumption at 48th hour after the surgery was lower at Group TAP (p = 0.022). Perioperative fentanyl consumption was lower at Group TAP (p < 0.001). Additional analgesic requirement and VAS were comparable between groups. Conclusions: Preemptive unilateral ultrasound-guided subcostal TAP block decreases perioperative fentanyl and postoperative total morphine consumption in PCNL patients compared to IV analgesic management.

The Effect of Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Study

“…Systemic opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and neuraxial methods such as epidural analgesia, paravertebral block, quadratus lumborum block (QLB), transversus abdominis plane (TAP) block, or local anesthetic infiltration along the nephrostomy tube can be employed to prevent postoperative pain caused by PCNL [5][6][7][8][9][10][11]. The use of NSAIDs is limited as these patients have potential renal problems.…”

Erector Spinae Plane Block for Perioperative Analgesia after Percutaneous Nephrolithotomy

“…Scientific findings support using paravertebral block or epidural anesthesia before PCNL to minimize the postoperative pain [16,17]. Local injection of analgesic drugs is also effective for this treatment [18][19][20][21]. Preventive preoperative intravenous or subarachnoid spinal analgesia was also described [22,23].…”

A Comparison of Analgesic Effect between Preoperative and Postoperative Transversus Abdominis Plane (TAP) Blocks for Different Durations of Laparoscopic Gynecological Surgery

“…Previous studies showed that it was inconsistent to determine the optimal time on TAP for patients undergoing surgeries. Some investigators recommended that TAP be performed before surgery [17,20,22]. Mansouri et al found that bilateral intrapleural block performed before cardiac surgery could get better analgesia than postoperative manipulation due to preemptive analgesia [25].…”

“…Previous studies showed that it was inconsistent to determine the optimal time on TAP for patients undergoing surgeries. Some investigators recommended that TAP be performed before surgery [17,20,22], some preferred postoperative performance [15,16,23,24], and others found that there was no difference between the two time points.…”