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

Estudo Original

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

Referências

1. Tekgül S, Stein R, Bogaert G, et al. European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Stone Disease. Eur Urol Focus. 2022;8: 833−9.

2. Wu H, Ding T, Yan S, Huang Z, Zhang H. Risk factors for moder- ate-to-severe postoperative pain after percutaneous nephroli- thotomy: a retrospective cohort study. Sci Rep. 2022;12:8366.

3. Ponde V. Recent trends in paediatric regional anaesthesia. Indian J Anaesth. 2019;63:746−53.

4. Akıncı G, Hatipoğlu Z, Güleç E, Özcengiz D. Effects of Ultra- sound-Guided Thoracic Paravertebral Block on Postoperative Pain in Children Undergoing Percutaneous Nephrolithotomy. Turk J Anaesthesiol Reanim. 2019;47:295−300.

5. Narasimhan P, Kashyap L, Mohan VK, et al. Comparison of caudal epidural block with paravertebral block for renal surgeries in pediatric patients: A prospective randomised, blinded clinical trial. J Clin Anesth. 2019;52:105−10.

6. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41:621−7.

7. Lima FV, Zandomenico JG, Prado M, Favreto D. Erector spinae plane block in pediatric orthopedic surgery: two case reports. Braz J Anesthesiol. 2020;70:440−2.

8. Lucente M, Ragonesi G, Sanguigni M, et al. Erector spinae plane block in children: a narrative review. Korean J Anesthesiol. 2022;75:473−86.

9. Damião VP, Andrade PP, de Oliveira LSG, Braga AFA, Carvalho VH. Efficacy of Erector Spinae Plane Block (ESPB) in pediatric cardiac surgeries: a systematic review and meta-analysis. Braz J Anesthesiol. 2025;75:844579.

10. Hopewell S, Chan AW, Collins GS, et al. CONSORT 2025 state- ment: updated guideline for reporting randomized trials. Nat Med. 2025;31:1776−83.

11. Nilsson S, Finnström B, Kokinsky E. The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years. Pae- diatr Anaesth. 2008;18:767−74.

12. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122:509−17.

13. Rai E, Naik V, Singariya G, Bathla S, Sharma R, Pani N. Recent advances in paediatric anaesthesia. Indian J Anaesth. 2023;67:27−31.

14. Chakraborty A, Khemka R, Datta T. Ultrasound-guided truncal blocks: A new frontier in regional anaesthesia. Indian J Anaesth. 2016;60:703−11.

15. El-Boghdadly K, Madjdpour C, Chin KJ. Thoracic paravertebral blocks in abdominal surgery −a systematic review of random- ized controlled trials. Br J Anaesth. 2016;117:297−308.

16. Nair S, Gallagher H, Conlon N. Paravertebral blocks and novel alternatives. BJA Educ. 2020;20:158−65.

17. Berta E, Spanhel J, Smakal O, Smolka V, Gabrhelik T, Lönnqvist PA. Single injection paravertebral block for renal surgery in chil- dren. Paediatr Anaesth. 2008;18:593−7.

18. Holland EL, Bosenberg AT. Early experience with erector spinae plane blocks in children. Paediatr Anaesth. 2020;30:96−107.

19. Aksu C, Gurkan Y. Defining the Indications and Levels of Erector Spinae Plane Block in Pediatric Patients: A Retrospective Study of Our Current Experience. Cureus. 2019;11:e5348.

20. Mostafa SF, Abdelghany MS, Abdelraheem TM. Abu Elyazed MM. Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy: A pro- spective randomized controlled trial. Paediatr Anaesth. 2019;29:1201−7.

21. Ali Gado A, Alsadek WM, Ali H, Ismail AA. Erector Spinae Plane Block for Children Undergoing Cardiac Surgeries via Sternot- omy: A Randomized Controlled Trial. Anesth Pain Med. 2022;12: e123723.

22. Bansal T, Kumar P, Kadian Y, et al. Comparison of ultrasound- guided sacral erector spinae plane block and caudal epidural block for analgesia in paediatric patients undergoing hypospa- dias repair: A double-blind, randomised controlled trial. Indian J Anaesth. 2024;68:725−30.

23. Abdelrazik AN, Ibrahim IT, Farghaly AE, Mohamed SR. Ultra- sound-guided Erector Spinae Muscle Block Versus Ultrasound- guided Caudal Block in Pediatric Patients Undergoing Lower Abdominal Surgeries. Pain Physician. 2022;25:E571−e80.

24. Mandour OA, Abdel-Aal IR, Salem CT, Refaat AR. Analgesic effect of ultrasound-guided erector spinae plane block versus ultra- sound-guided caudal block in pediatric open renal surgeries: A ran- domized comparative study. Bali J Anesthesiol. 2023;7(2).

25. Liu J, Fang S, Wang Y, et al. The safety and efficacy of ultra- sound-guided erector spinae plane block in postoperative anal- gesic of PCNL: A systematic review and meta-analysis. PLoS One. 2023;18:e0288781.

26. Khot PP, Desai SN, Bale SP, Aradhya BN. Comparison of ultra- sound-guided paravertebral block versus erector spinae plane block for postoperative analgesia after percutaneous nephroli- thotomy - A randomised, double-blind, controlled study. Indian J Anaesth. 2023;67:1110−5.

27. Fan Q, Liu H, Li Y, Dai H, Wang Y. Comparison of ultrasound- guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after laparoscopic nephrec- tomy: a randomized controlled non-inferiority clinical trial. Minerva Anestesiol. 2023;89:520−8.

28. Ardon AE, Lee J, Franco CD, Riutort KT, Greengrass RA. Paraver- tebral block: anatomy and relevant safety issues. Korean J Anesthesiol. 2020;73:394−400.

29. Pawa A, King C, Thang C, White L. Erector spinae plane block: the ultimate ‘plan A’ block? Br J Anaesth. 2023;130:497−502.

30. Moustafa MA, Alabd AS, Ahmed AMM, Deghidy EA. Erector spinae versus paravertebral plane blocks in modified radical mastec- tomy: Randomised comparative study of the technique success rate among novice anaesthesiologists. Indian J Anaesth. 2020;64:49−54.

31. Vecchione T, Zurakowski D, Boretsky K. Thoracic Paravertebral Nerve Blocks in Pediatric Patients: Safety and Clinical Experi- ence. Anesth Analg. 2016;123:1588−90.

32. De Cassai A, Geraldini F, Carere A, Sergi M, Munari M. Complica- tions Rate Estimation After Thoracic Erector Spinae Plane Block. J Cardiothorac Vasc Anesth. 2021;35:3142−3.

Submetido em:
24/06/2025

Aceito em:
25/01/2026