الفهرس 
UltrasoundOnly 14 pages are availabe for public view
 |  | from | 164 |  |  |
| | | from | 164 | | |
Abstract
The pain during ESWL is multifactorial, differing with the type of lithotripter, the frequency of shockwave delivery, the voltage applied, and the age and sex of the patient. Clinical outcomes and success as measured in terms of stone-free rate after ESWL is strongly correlated to pain experienced during treatment.Many drugs and methods such as local anesthetic infiltration, IV or oral NSAIDs and/or opioid agents have been used for pain management during ESWL. Nonetheless, the most effective analgesic regimen during ESWL has not been determined. The TPVB is the technique of injecting local anesthetic alongside the vertebra close to where the spinal nerves emerge from the intervertebral foramina. This produces ipsilateral somatic and sympathetic nerve blockade in multiple contiguous dermatomes both above and below the site of injection. It is used as an alternative opioid-sparing strategy to epidural analgesia following major thoracoabdominal surgeries. With the use of ultrasound, regional anesthetic techniques have become safer with fewer complications rate. Therefore, there has been an increase in interest in the use of ultrasound to assist or guide TPVB in real time. Our prospective randomized study aimed to evaluate the effectiveness of ultrasound-guided TPVB versus sedative analgesic drugs using IV midazolam (0.05 mg/kg)/fentanyl (1 μg /kg) in patients undergoing ESWL procedure. The primary outcome was the pain intensity during the procedure. Secondary outcomes were patient’s satisfaction with their analgesic technique and the success rate of the ESWL procedure. Summary 107 This study was carried out in Tanta University Hospitals from June 2019 to May 2020 on sixty patients aged 20-60 years, with radio-opaque renal stone not more than 1.5 cm undergoing ESWL. After approval of Institutional Ethical Committee, a written informed consent was obtained from each patient. Patients were randomly allocated into two equal groups: group I (TPVB): Patients received ipsilateral ultrasound-guided TPVB at the level T9-T10 using bupivacaine 0.25% (20ml) about 30 minutes before the ESWL procedure. group II (midazolam/fentanyl): Patients received sedative analgesic drugs using IV midazolam (0.05 mg / kg) and fentanyl (1 μg/kg) about 5 min before the ESWL procedure. Measurements: Following measurements were assessed: 1. VAS score was measured on scale from (0-100; where 0= no pain and 100=the worst pain) pre-procedure, during procedure every 10 min at regular interval and at 30 min after the procedure. 2. Total dose of rescue analgesic consumption during ESWL procedure. 3. Duration of ESWL session (min), which is, defined as time needed until finishing of 3000 shock waves. 4. Rate of successful ESWL, which is, defined as elimination of stone fragments within1-2 months. Summary 108 5. Number of ESWL sessions needed. 6. Time needed for stone clearance. 7. Patient satisfaction using a 5- point score; (0 = very dissatisfied, 1 = dissatisfied, 2 = neither satisfied nor dissatisfied, 3 = satisfied and 4 = verysatisfied). 8. Operator satisfaction using the same previous 5- point score. 9. Number of patients required postoperative analgesia (diclofenac sodium). 10. Heart rate, mean arterial blood pressure and O2 saturation, were measured pre–procedure and during procedure every 10 min at regular interval and at 30 min after the procedure. 11. Time needed for home discharge (calculated from the end of the ESWL procedure till home discharge). 12. Complications such as mild hematuria, nausea and vomiting.