INTRODUCTION
Pain, which is defined as a rather uncomfortable physical sensation caused due to any illness or injury, is one of the most common causes of consulting with the emergency department (ED). Acute renal colic is a clinical condition characterized by severe, widespread flank pain and often accompanied by urinary tract stones. Its prevalence worldwide is 5-15% 1. Laboratory examinations and imaging procedures are performed to expose urolithiasis or to exclude other possible early diagnoses following the first symptomatic treatment like hydration. Those patients for whom emergency surgery is not planned following the diagnosis are generally followed up with analgesic protocols.
To determine the suitable analgesic protocol, such parameters as medication efficacy, safety and accessibility are determinants along with the patient’s pain score. Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids constitute the foundation of today’s acute renal colic analgesic protocols. Since opioids can be titrated based on the severity of the pain and has high level of efficacy, they are still commonly used at several healthcare centers. However, due to the risk of drug abuse and respiratory depression, as well as considering its adverse effects such as nausea-vomiting, NSAIDs are accepted as the first line medication since they have an analgesic efficacy similar to that of opioids 2. Just like opioids, NSAIDs are not innocent either in terms of their adverse effects. Additionally, various agents such as paracetamol, ketamine, calcium channel blockers, alpha blockers, vasopressin analogs and magnesium sulfate were used for analgesic management of acute renal colic 3-5. In addition to these medical treatments, such regional analgesic techniques as trigger point injection 6, twelfth intercostal nerve block 7, and subcutaneous paravertebral block8 were also employed. Ultrasound-guided application of regional anesthesia techniques has higher rates of success and lower risk of complications. Especially the plane blocks for which a new form is defined each passing day are way easier to learn and to practice, which makes them preferable by various clinicians.
Moreover, when performed with ultrasound guidance, regional anesthesia techniques have gained a tremendous amount of popularity in eliminating acute pain over the recent years. To conclude, the ultrasound-guided plane blocks have been included in the multi-model analgesic concept as a non-opioid analgesic option 9. The ultrasound-guided erector spinae plane (ESP) block, which was first defined with thoracic neuropathic pain management by Forero 10, is currently routinely used in several surgical procedures for postoperative analgesia 11,12, and it is also used in the analgesic management of various acute and chronic pain 13,14. We have shared a presentation of three cases to point out to the analgesic efficacy that the ESP block might potentially have in acute renal colic15. To the best of our knowledge, the present study is the first randomized pilot clinical study that shows the efficacy of ESP block in the analgesic management of acute renal colic.
The primary aim of the present study is to evaluate the effect of ESP block on the opioid consumption in the analgesic management of acute renal colic while the second one is to evaluate its effect on pain scores.