LETTERS TO EDITOR
Year : 2023 | Volume
| Issue : 1 | Page : 132-133
Continuous retrolaminar block in percutaneous nephrolithotomy surgery
Poonam Kumari1, Amarjeet Kumar2, Chandni Sinha1, Ajeet Kumar1, Anu Kumari1
1 Department of Anaesthesiology, AIIMS, Patna, Bihar, India
2 Department of Trauma and Emergency, AIIMS, Patna, Bihar, India
Room no 503, Hostel 11, AIIMS, Patna, Bihar
Source of Support: None, Conflict of Interest: None
|Date of Submission||03-Jul-2022|
|Date of Decision||03-Jul-2022|
|Date of Acceptance||04-Jul-2022|
|Date of Web Publication||02-Jan-2023|
|How to cite this article:|
Kumari P, Kumar A, Sinha C, Kumar A, Kumari A. Continuous retrolaminar block in percutaneous nephrolithotomy surgery. Saudi J Anaesth 2023;17:132-3
|How to cite this URL:|
Kumari P, Kumar A, Sinha C, Kumar A, Kumari A. Continuous retrolaminar block in percutaneous nephrolithotomy surgery. Saudi J Anaesth [serial online] 2023 [cited 2023 Feb 3];17:132-3. Available from: https://www.saudija.org/text.asp?2023/17/1/132/364860
A retrolaminar block (RLB) is a modified paravertebral technique with a local anaesthetic injected at the retrolaminar site. It is an easier technique than the ultrasound-guided paravertebral block that is technically challenging, time consuming, and related to important risks. RLB was first described by Pfeiffer et al. in 2006.
We describe a case of percutaneous nephrolithotomy (PCNL) surgery that was carried out under general anaesthesia with ultrasound-guided continuous RLB. Written and informed consent was taken for publication. A 31-year-old male patient weighing 60 kg having left renal calculus scheduled for PCNL under general anesthesia. After induction of anaesthesia, continuous RLB was performed at the level of T9 Lamina. A linear USG probe (M-Turbo, Fujifilm Sonosite, Inc., Bothell, WA, USA) was placed longitudinally in midline to identified spinous process of T9 vertebra. Following this, the US probe was slide slightly laterally towards the operating side to identify following structures: the lamina (horse head sign of hyperechoic structure) and erector spinae muscle. The needle (Pajunk E-Cath, karl-Hall-Strasse, 78187, Germany) was inserted in-plane to the probe in caudal to cranial direction towards the T9 lamina (1–1.5 cm lateral to the target spinous process) and needle tip was contacted with lamina [Figure 1]. After negative aspiration for blood and air, 0.125% bupivacaine of total volume 20 ml was injected. This also facilitated the insertion of catheter in the desired plane [Figure 1]. Postoperative multimodal analgesia consisted of intravenous paracetamol 10 mg/kg every 6 h combined with intermittent bolus dose of bupivacaine 0.125% 20 ml was injected via indwelling catheter every 8 h for 3 days. Numerical Rating Scale at 24-h pain scores was 2. Rescue analgesia was not required. The postoperative period was uneventful, and he was discharged without the need for analgesics. The principal mechanism of action in the RLB for analgesia can be explained by local anesthetic spreading anteriorly through the superior costotransverse ligaments into either the paravertebral space, epidural spaces, or intervertebral foramen. The efficacy of continuous RLB has been reported for breast cancer surgery by landmark technique and rib fracture. These reports of successful cases indicated RLB to be an effective method as an alternative to Paravertebral block and are advantageous in that they are easier and safer techniques performed in more superficial tissue plane. Needle trajectory and injection point that are relatively easy to visualize and farther away from the pleurain comparison to the traditional paravertebral block. Continuous RLB as an adjunct to general anaesthesia provide effective surgical analgesia and satisfactory postoperative pain control in PCNL surgery.
|Figure 1: Ultrasound-guided continuous retrolaminar block. Picture shows the entry of a needle coming into contact with the T9 lamina|
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Taken from the patient.
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| References|| |
Pfeiffer G, Oppitz N, Schöne S, Richter-Heine I, Höhne M, Koltermann C. [Analgesia of the axilla using a paravertebral catheter in the lamina technique]. Anaesthesist 2006;55:423-7.
Onishi E, Toda N, Kameyama Y, Yamauchi M. Comparison of clinical efficacy and anatomical investigation between retrolaminar block and erector spinae plane block. Biomed Res Int 2019;2019:2578396.doi: 10.1155/2019/2578396.
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. The paraverte- bral lamina technique: A new regional anesthesia approach for breast surgery. J Clin Anesth 2011;23:443-50.
Voscopoulos, C, Palaniappan D, Zeballos J, Ko H, Janfaza, D, Vlassakov K. The ultrasound-guided retrolaminar block. Can J Anesth 2013;60:888-95.
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