الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Surgical pain is a universal phenomenon affecting all patients in the intraoperative and postoperative period. Apart from an agonizing sensory experience associated with it, acute pain has several deleterious effects on the physic and the psyche of the sufferer. An anticipation of these effects combined with a humanitarian urge to relieve pain, play a pivotal role in provision and optimization of postoperative analgesia.
Intravenous opioids had been usually administered for acute postoperative pain. However, extensive use of opioids is associated with multiple perioperative side-effects such as respiratory depression, PONV, drowsiness and sedation that can prolong hospital stay and delay discharge. Many studies have been carried out in an attempt to find a solution for these dilemma and hence different analgesic modalities such as local infiltration of the surgical wound, systemic analgesia, neuro-axial blocks and regional nerve blocks have been defined.
Multiple techniques of regional anaesthesia can be used for perioperative pain relief. TEA has been considered the gold standard for postoperative pain relief. It has been shown to improve surgical outcomes, however, it has multiple drawbacks such as epidural haematoma, infections like meningitis and haemodynamic instability caused by sympathetic blockade.
PVB is an alternative to TEA for postoperative pain relief after surgery. PVB offers comparable analgesia to TEA with fewer adverse effects, such as PONV, hypotension and urinary retention. However, this is still a challenging technique, as the needle is placed in immediate proximity to the pleura which makes even the ultrasound-guided PVB technique a risk for pleural puncture and pneumothorax.
More recently, a novel interfascial plane block, ESP block has been described in 2016 by Forero et al as an effective postoperative analgesic technique in various surgeries and chronic neuropathic thoracic pain in adults. The ESP block is done by injecting the LA solution within the fascial plane deep to the ESM at the apex of the transverse process of the vertebra.
This prospective randomized study investigates the efficacy of US-guided paravertebral block (PVB) and erector spinae block (ESPB) in managing postoperative pain among adult patients undergoing elective nephrectomy. Effective pain management is crucial for enhancing patient comfort and promoting a swift recovery following major surgical procedures like nephrectomy.
The study involves 50 adult patients scheduled for elective nephrectomy, randomly assigned to receive either ultrasound-guided PVB or ESPB. Visual pain intensity scores and duration of analgesia are employed as key outcome measures. The comparative analysis aims to provide insights into the effectiveness of both techniques in alleviating postoperative pain.
The results reveal comparable effectiveness between PVB and ESPB, as indicated by similar visual pain intensity scores and duration of analgesia. Both techniques demonstrate the potential to successfully mitigate postoperative pain in this patient population.
The findings underscore the significance of adequate pain control in the context of elective nephrectomy. The comparable efficacy of PVB and ESPB suggests that either technique can be successfully employed for optimal pain management, contributing to critical aspects of the recovery process such as early mobilization and respiratory function.
This study contributes valuable insights into the use of ultrasound-guided PVB and ESPB for pain management in elective nephrectomy. The results highlight the comparable effectiveness of both techniques in alleviating postoperative pain, emphasizing their potential role in enhancing patient comfort and supporting a smooth recovery process