Comparison of peritubal infiltration and single level T10 paravertebral block in percutaneous nephrolithotomy (PCNL)

BACKGROUND AND AIMS: In percutaneous nephrolithotomy (PCNL), distension of renal capsule, pelvicalyceal system and nephrostomy tube causes intense postoperative pain. The present study was done to compare the efficacy of peritubal infiltration of Ropivacaine with Dexmedetomidine and ultrasound guided single level T10 paravertebral block for post-operative analgesia in patients undergoing PCNL. MATERIAL AND METHODS: A prospective, double blind study was conducted on 60 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing PCNL who were randomized into 3 groups. Group PV [n = 20] received paravertebral block at T 10 level with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group PT [n = 20] received peritubal infiltration along nephrostomy tube with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group C [n = 20] control group received intravenous Tramadol 1mg/kg. Postoperative pain scores, opioid consumption and side effects if any were recorded for 24 hrs. Statistical analysis was done using ANOVA test, Chi-square test. P value <0.05 was considered significant. RESULTS: Demographic data were comparable. Reduced dynamic VAS score was noted for first 8hrs in peritubal infiltration compared to paravertebral group. Dynamic VAS scores were significantly lower in paravertebral group at 8(th), 12(th) and 24(th) hr as compared to peritubal infiltration (P < 0.05). During all time intervals peritubal infiltration and paravertebral group had significantly lower VAS scores as compared to control group. Opioid requirement was more in control group compared to study groups. CONCLUSION: In PCNL, peritubal infiltration and single level paravertebral block produces effective postoperative analgesia without significant side effects.