Ultrasound-guided erector spinae plane block with dexmedetomidine as an adjuvant to ropivacaine versus plain ropivacaine for postoperative analgesia following percutaneous nephrolithotomy: A prospective randomised double-blind research

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Can the addition of dexmedetomidine to ropivacaine in an ultrasound-guided erector spinae plane (ESP) block meaningfully extend pain relief after percutaneous nephrolithotomy (PCNL)? This prospective, randomised, double-blind research enrolled 82 adult patients aged 18-65 years, ASA grade I-II, scheduled for elective PCNL at Nakuru Research Institute, Kenya between March 2024 and November 2024. After randomisation, 41 patients received 20 mL of 0.375% ropivacaine with 1 mcg/kg dexmedetomidine (Group RD) and 41 received 20 mL of 0.375% ropivacaine with normal saline (Group R) via ultrasound-guided ESP block at the T9 transverse process level before general anaesthesia induction. Six patients were excluded from the final analysis owing to protocol deviations and incomplete records, leaving 38 patients per group. The main outcome measured was cumulative morphine consumption over the first 24 postoperative hours. Secondary endpoints included visual analogue scale (VAS) pain scores at 0, 2, 4, 6, 12 and 24 hours, time to first rescue analgesic request, block performance time, haemodynamic parameters and adverse events. Group RD consumed markedly less morphine in 24 hours compared with Group R (8.3 ± 2.1 mg versus 14.7 ± 3.4 mg; p < 0.001). VAS scores were lower in Group RD at all time points from 2 hours onward (p < 0.05). Median time to first rescue analgesia was 7.4 hours (IQR 5.8-9.1) in Group RD versus 3.6 hours (IQR 2.9-4.8) in Group R (p < 0.001). The incidence of bradycardia, hypotension, nausea and sedation did not differ between groups (p > 0.05). Adding dexmedetomidine at 1 mcg/kg to ropivacaine in ESP blocks after PCNL offers better analgesia, reduces opioid needs and extends pain-free intervals without raising the side-effect burden.

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