INTRODUCTIONThis study aimed to explore the potentialSummaryPercutaneous nephrolithotomy (PCNL) remains the forebenefits and safety considerations of combinmost therapeutic approach for addressing large, complex,ing ultrasound-guided quadratus lumborum block (QLB) withand multiple renal calculi, consistently demonstratinglow-dose spinal anesthesia (LDSA) versus general anesthesiasuperior efficacy in cases where stone burden exceeds 2(GA) for individuals undergoing percutaneous nephrolithotomycm. This minimally invasive procedure offers several(PCNL). This prospective randomized controlled trial includedadvantages, including reduced trauma, lower intraopera70 adult patients undergoing PCNL, divided into Group Qtive blood loss, and a favorable safety profile (1).(QLB + LDSA, n = 35) and Group G (GA, n = 35). PrimaryHowever, despite these benefits, PCNL is frequently assooutcomes included postoperative pain, assessed using the Visualciated with significant postoperative challenges such asAnalog Scale (VAS), and opioid consumption, measured bysevere pain, intestinal paralysis, and surgical stress, whichpethidine usage. Secondary outcomes included patient satisfaccan delay recovery and early mobilization (2).tion, stone clearance rates, hemoglobin and creatinine changes,General anesthesia (GA) remains the most commonly usedand adverse events. Multivariate regression analysis identifiedanesthetic method for PCNL, offering reliable intraoperapredictors of outcomes. Postoperative pain scores were signifitive conditions (3). However, its limitations, particularlycantly lower in Group Q during the first 8 postoperative hoursin elderly and high-risk patients, include potential com(all p < 0.001). Median pethidine consumption was lower inplications with patient positioning, interference with resGroup Q (70 mg vs. 105 mg, p < 0.001). Group Q demonstratedpiratory and circulatory systems, and delayed recoverysuperior patient satisfaction, with 82.8% of individuals ratingdue to the slower metabolism of anesthetic agents in certheir experience as "satisfied" or "very satisfied," markedlytain populations (4).exceeding the 8.6% observed in Group G (p < 0.001). StoneTo address these challenges, alternative anesthesia techclearance outcomes were comparable between the groups, withniques are being explored for their ability to provide effecno statistically significant difference in residual stone burdentive and safe pain management. Quadratus lumborum block(p = 0.348).(QLB) has emerged as a promising regional anesthesiaNo significant differences were observed in postoperative hemotechnique. It provides prolonged analgesia for abdominalglobin levels (Group Q: 11.5 ± 0.6 g/dL vs. Group G: 11.5 ± 0.6wall and visceral pain, with effects lasting 24 to 48 hoursg/dL, P = 1.0) or serum creatinine levels (Group Q: 1.0 ± 0.2postoperatively, promoting early recovery and reducingmg/dL vs. Group G: 1.0 ± 0.2 mg/dL, p = 0.611). In PCNLopioid consumption. Several QLB approaches have beenprocedures, QLB in conjunction with LDSA demonstrates supedeveloped, including QL1, QL2, QL3, and QL4, based onrior postoperative analgesia, reduced opioid requirements, andthe anatomical site of local anesthetic injection, all ofimproved patient satisfaction while maintaining comparablewhich show potential in improving postoperative outperioperative and urological outcomes.comes (5).Although QLB has demonstrated promising analgesic effiKE |
