oa Paravertebral block is alternative anesthesia for outpatient lithotripsy

This study evaluated the effectiveness of paravertebral block as alternative anesthetic technique for extracorporeal shock wave lithotripsy (ESWL) procedure. Fifty patients with renal stones, aged 20 to 60 years, were randomly allocated into two groups; twenty five patients in group P; received unilateral paravertebral block from T8 through L1 with injection of 5ml 0.5%bupivacaine and 25 patients in group L; received local infiltration by bupivacaine 0.25%(2mg/kg) into the 30 cm2 area after localizing the stones site, 10 minutes before the session. 10 mm visual analogue scale (VAS) was used to evaluate pain every 10 minutes during the session. At the end of the procedure, total doses of rescue analgesia, the number of shockwaves, their power and the total duration of shockwave treatment were recorded. After completion of the procedure the patient was assessed for pain and nausea in the post anesthesia Care Unit (PACU) using the Visual Analog Scale. Patient's satisfaction and time needed to discharge patients to home also were recorded. Time to do the anesthetic technique was significantly higher (p<0.001) in group-P than group-L, it was 12.7±2.3 minutes versus 6.9±1.9 minutes respectively, intraoperative rescue analgesia by fentanyl was lesser (P<0.001) in group-P than group-L, 26.7 ± 6.32mcg versus 78.6±5.41mcg, respectively, also time interval between ends of the procedure till discharge to home was significantly higher (P<0.001) in group-P than group-L, it was 99±17 minuets versus 133±31minuits respectively. VAS was not significant difference between both groups either intraoperative or postoperative in first hour. Patient's satisfaction was significantly higher (P<0.05) in group-P than group-L, it was 8.8±1.1 versus 6.1±0.6, respectively. Adverse events were lesser, but not significant in group-P than in group-L. Two patients (8%) in group-L and one patient (4%) in the group-P experienced episodes of postoperative nausea and vomiting (PONV). Paravertebral block is effective alternative anesthesia for outpatient lithotripsy; multiple level paravertebral blocks provide an optimal anesthetic condition, with acceptable adverse events for ESWL. And providing proper analgesia during the procedure and in first hour after finishing of the procedure, early discharge to home and providing better patient's satisfactions.