Study setting and population
The study was conducted at a single healthcare center, which was the ED
of a tertiary university hospital. Excluded patients included from the
study those who were planned to be operated urgently, had severe
systemic diseases (renal, hepatic, pulmonary, and endocrine diseases),
had bilateral obstruction, with a single kidney, anuric patients,
pregnant and breastfeeding, allergic to the medication to be used.
After admission to ED, computerized tomography and laboratory procedures
were performed for the diagnosis of urolithiasis. Intravenous hydration
was administered to all patients as an initial treatment, and the
patients were assigned into two equal groups according to computer
randomization program as;
Group NSAID: Patients included in the NSAID group were
administered a 5 min i.v. injection of 50 mg dexketoprofen trometamol
(Arveles 50mg/2 ml ampule, Ufsa Medication Industry and Trade Inc.,
Turkey) diluted in 20 mL of normal saline.
Group ESP: The patient was placed in the seated position. The
skin was prepared with antiseptic solutions. Then the transverse process
and the erector spina muscle were identified in the sagittal plane with
multifrequency linear probe (Toshiba Aplio XG Diagnostic Ultrasound
System, 04/2016 Japan) placed longitudinal parasagittal orientation at
3 cm lateral of the midline at T8 vertebrae level. While the needle
(Braun Stimuplex® Ultra 360, Melsungen, Germany) was advanced by
in-plane technique, plane was verified by performed hydro-dissection
with 3 ml saline. ESP block was administered by injection of 30 ml
0.25% bupivacaine and into the fascial plane between the transverse
process and erector spinae muscle (Figure 1).