Correspondence Address:
Amarjeet Kumar
Room no 503, Hostel 11, AIIMS, Patna, Bihar
India

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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.[1]

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.[2] The efficacy of continuous RLB has been reported for breast cancer surgery by landmark technique[3] and rib fracture.[4] 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}

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References