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

BACKGROUND: 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. METHODS: bupivacaine 0.25% in epinephrine 1:100000. The primary outcome was time to first rescue analgesia (nalbuphine). RESULTS: 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). CONCLUSION: 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.