Erector spinae plane block versus thoracic
paravertebral block in pediatric patients undergoing
percutaneous nephrolithotomy: a prospective
randomized clinical trial

Fatma Nabil; Ahmed M. Mandour; Amr M. Abdelgawad; Deiaaeldin M. Tamer; Ahmed A. Shahat; Mohamed Anwar; Hany M. Osman

doi:10.1016/j.bjane.2026.844735

Original Investigation

Erector spinae plane block versus thoracic paravertebral block in pediatric patients undergoing percutaneous nephrolithotomy: a prospective randomized clinical trial

Bloqueio do plano do músculo eretor da espinha versus bloqueio paravertebral torácico em pacientes pediátricos submetidos à nefrolitotomia percutânea: ensaio clínico prospectivo randomizado

Fatma Nabil, Ahmed M. Mandour, Amr M. Abdelgawad, Deiaaeldin M. Tamer, Ahmed A. Shahat, Mohamed Anwar, Hany M. Osman

http://dx.doi.org/10.1016/j.bjane.2026.844735 Braz J Anesthesiol, vol.76, n3, 844735, 2026

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Abstract

Background

Percutaneous Nephrolithotomy (PCNL) is a well-established surgical procedure for removal of large, multiple, and complex renal calculi in children. Combining loco-regional techniques with general anesthesia has gained increasing popularity in pediatric anesthesia. The objective of this trial was to evaluate the efficacy of Erector Spinae Plane Block (ESPB) versus thoracic Paravertebral Block (PVB) in pediatric patients undergoing PCNL procedure.

Methods

Fifty-six children, aged 2‒7 years, who underwent PCNL procedure under general anesthesia were randomly assigned to receive either ESPB (n = 28) or thoracic PVB (n = 28) with the same anesthetic mixture of 0.3 mL.kg^-1 bupivacaine 0.25% in epinephrine 1:100000. The primary outcome was time to first rescue analgesia (nalbuphine).

Results

The time to first rescue analgesia was 15.98 ± 10.17 hours (95% CI: 12.14–19.82) in the ESPB group versus 18.18 ± 9.18 hours (95% CI: 14.7–21.58) in the thoracic PVB group with no significant difference (p = 0.464, log-rank test). Moreover, the total dose and frequency of administration of nalbuphine during the first 24 postoperative hours were comparable between the two studied groups (p = 0.488 and 0.479 respectively). However, the time to conduct the block was significantly shorter in the ESPB group versus the thoracic PVB group (4.37 ± 1.08 minutes vs. 5.05 ± 1.17 minutes respectively, p = 0.028).

Conclusion

ESPB was not found to be more effective than thoracic PVB for postoperative pain management in children undergoing PCNL procedure. Moreover, intraoperative hemodynamics and maximum sevoflurane concentration were comparable. The time to conduct ESPB was significantly shorter; hence, it could be considered as an easy alternative to thoracic PVB for this procedure.

Keywords

Analgesia; Anesthesia; Block; Pediatric; Percutaneous nephrolithotomy; Postoperative pain

Resumo

Introdução

A nefrolitotomia percutânea (Percutaneous Nephrolithotomy — PCNL) é um procedimento cirúrgico bem estabelecido para remoção de cálculos renais grandes, múltiplos e complexos em crianças. A combinação de técnicas locorregionais com anestesia geral tem ganhado crescente popularidade na anestesia pediátrica. O objetivo deste estudo foi avaliar a eficácia do bloqueio do plano do músculo eretor da espinha (Erector Spinae Plane Block — ESPB) versus bloqueio paravertebral torácico (Paravertebral Block — PVB) em pacientes pediátricos submetidos ao procedimento de PCNL.

Métodos

Cinquenta e seis crianças, com idade entre 2 e 7 anos, submetidas à PCNL sob anestesia geral, foram randomicamente distribuídas para receber ESPB (n = 28) ou PVB torácico (n = 28), utilizando a mesma mistura anestésica de 0,3 mL.kg⁻¹ de bupivacaína a 0,25% em epinefrina 1:100000. O desfecho primário foi o tempo até a primeira analgesia de resgate (nalbufina).

Resultados

O tempo até a primeira analgesia de resgate foi de 15,98 ± 10,17 horas (IC 95%: 12,14–19,82) no grupo ESPB versus 18,18 ± 9,18 horas (IC 95%: 14,7–21,58) no grupo PVB torácico, sem diferença significativa (p = 0,464; teste de log-rank). Além disso, a dose total e a frequência de administração de nalbufina durante as primeiras 24 horas pós-operatórias foram comparáveis entre os dois grupos estudados (p = 0,488 e 0,479, respectivamente). Entretanto, o tempo para realização do bloqueio foi significativamente menor no grupo ESPB em comparação ao grupo PVB torácico (4,37 ± 1,08 minutos vs. 5,05 ± 1,17 minutos, respectivamente; p = 0,028).

Conclusão

O ESPB não se mostrou mais eficaz que o PVB torácico para o manejo da dor pós-operatória em crianças submetidas à PCNL. Além disso, a hemodinâmica intraoperatória e a concentração máxima de sevoflurano foram comparáveis. O tempo para realização do ESPB foi significativamente menor; portanto, ele pode ser considerado uma alternativa mais simples ao PVB torácico para esse procedimento.

Palavras-chave

Analgesia; Anestesia; Bloqueio; Pediátrico; Nefrolitotomia percutânea; Dor pós-operatória

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Submitted date:
06/24/2025

Accepted date:
01/25/2026