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).