Paravertebral Block for Percutaneous Nephrolithotomy

The strategies used to manage nephrolithiasis including medical expulsive therapy,
extracorporeal shock wave (ESWL), ureteroscopy, open surgery and percutaneous nephrolithotomy
(PCNL). PCNL in an inpatient procedure performed in two steps. Step 1, is the placement of a
drainage line (nephrostomy tube) from the back into the collecting system of the kidney. This
step is typically performed by interventional radiologists under conscious sedation. Step 2
is performed by urologists and involves dilating the tract of the nephrostomy tube, placement
of an access sheath and actual removal of the stone using endoscopic equipment. The minimally
invasive approach of PCNL is well accepted to be as effective as open procedures for stone
removal with less morbidity. Post-operative pain management remains challenging and can lead
to extended hospital stays.

This randomized, double-blinded trial designed to assess the effects of paravertebral block
on intra-operative and post-operative pain control.

Inclusion Criteria:

- Consent to undergo percutaneous nephrolithotomy

- Between the ages of 18 and 75

- Able to consent, fill out study documents, and complete all study procedures and
follow-up visits

Exclusion Criteria:

- Will have bilateral percutaneous nephrolithotomy

- Have an infection at the site of the proposed block

- Have anatomy that prevents ability to perform block

- Have a coagulopathy which may increase their chances of bleeding from the block

- Have a known allergy to local anesthetics

- Are unable to fill out the VAS scale due to physical or mental conditions

- Are unable to use a patient controlled analgesia (PCA) device due to physical or
mental conditions

- Are pregnant