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.