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Introduction: To assess the effects of pre-operative paravertebral block (PVB) prior to PCNL.
Materials & Methods: A retrospective review of 34 consecutive patients who underwent PVB prior to PCNL was performed and compared to a control cohort of 54 PCNLs who did not undergo PVB (total 88 patients). In the surgical induction area, single shot ultrasound guided PVB was performed. At prone position, the block was done at T10 level with 20-30 ml 0.5% Bupivacaine with epinephrine 1:400,000. PCNL procedures were performed in the prone position under general anesthesia using fluoroscopic guidance and a standard 30 Fr renal access sheath. Results: Thirty-four (34) patients underwent PVB while 54 patients did not. Use of paravertebral block was associated with significantly lower incidence of post-operative nausea/vomiting (11% versus 33%, p = 0.02), lower PACU pain score (2.5 versus 4.7, p = 0.003) and a trend towards lower intraoperative morphine use (5.1 mg versus 7.6 mg, p = 0.06) as well as length of stay
(29.8 hours versus 37.2 hours, p = 0.125). PVB patients were slightly older than non-PVB patients (61 years versus 55 years, p=0.03). ASA class, gender distribution (29% female versus 33% female), stone size (76% greater than 2 cm versus 65% greater than 2 cm), use of nephrostomy tube (41% versus 39%), and BMI (29.2 versus 31.1) and history of preoperative opioid use (14.7% versus 9.3%) were not different between the two groups.
Conclusions: PVB was associated with significant improvements in post-operative nausea/vomiting and PACU pain scores.