Analgesic efficacy of triple-level erector spinae plane block versus triple-level costotransverse foramen block in patients undergoing percutaneous nephrolithotomy surgery: A randomised non-inferiority trial

Background and Aims: Percutaneous nephrolithotomy (PCNL), although minimally invasive, causes moderate to severe pain after surgery. In regional anaesthesia techniques, such as the erector spinae plane block (ESPB) and costotransverse foramen block (CTFB), local anaesthetic reaches the paravertebral space, focussing on the dorsal rami and intercostal nerves. The aim of this study was to assess the postoperative analgesic efficacy of triple level ultrasound guided ESPB versus triple level ultrasound guided CTFB in patients undergoing PCNL surgery under general anaesthesia. In this study, three injections of study drug at three consecutive levels (triple-level) were given, anticipating adequate craniocaudal spread. Methods: In this randomised, double-blind, parallel group trial, 50 adults set to undergo PCNL with general anaesthesia were randomised to two groups: Group I (ESPB, n = 25) and Group II (CTFB, n = 25). Before anaesthesia, patients received an ultrasound guided triple level block with 0. 375% ropivacaine (7 mL at each of the T10, T11, and T12 levels, for a total of 21 mL) on the operative side. The statistical analyses were performed using SPSS version 23. 0, employing the independent t -test, Mann–Whitney U test, paired t -test, and Chi-square test. Results: The median cumulative morphine use over 24 hours was 7 mg in both groups ESPB: interquartile range (IQR) 4–11. 75 mg; CTFB: IQR 3–11 mg (P = 0. 267). Conclusion: Postoperative analgesia provided by triple level ESPB was not inferior to triple level CTFB and thus can be used as an effective analgesic technique for PCNL surgeries.