Paravertebral Block for Percutaneous Nephrolithotomy (PRONE)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT01480102
Recruitment Status : Recruiting
First Posted : November 28, 2011
Last Update Posted : March 30, 2017
Information provided by (Responsible Party):
Thomas Turk, Loyola University

Brief Summary:
This study will compare post-operative pain levels in patients who receive paravertebral block prior to Percutaneous Nephrolithotomy (PCNL) surgery versus those who do not receive the block. We hypothesize that patients who receive the block will have lower post-operative pain scores and require less narcotics.

Condition or disease Intervention/treatment
Post Operative Pain Drug: Group A-Paravertebral block Other: Group B- No block

Detailed Description:

The strategies used to manage nephrolithiasis including medical expulsive therapy, extracorporeal shock wave (ESWL), ureteroscopy, open surgery and percutaneous nephrolithotomy (PCNL). PCNL in an inpatient procedure performed in two steps. Step 1, is the placement of a drainage line (nephrostomy tube) from the back into the collecting system of the kidney. This step is typically performed by interventional radiologists under conscious sedation. Step 2 is performed by urologists and involves dilating the tract of the nephrostomy tube, placement of an access sheath and actual removal of the stone using endoscopic equipment. The minimally invasive approach of PCNL is well accepted to be as effective as open procedures for stone removal with less morbidity. Post-operative pain management remains challenging and can lead to extended hospital stays.

This randomized, double-blinded trial designed to assess the effects of paravertebral block on intra-operative and post-operative pain control.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 82 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Paravertebral Block for Percutaneous Nephrolithotomy (PRONE)
Study Start Date : August 2011
Estimated Primary Completion Date : August 2017
Estimated Study Completion Date : August 2017

Arm Intervention/treatment
Placebo Comparator: Group B- No Block
Participants randodmized to this arm will have a local anesthetic injection and pressure applied to the paravertebral space. A paravertebral injection will not be conducted.
Other: Group B- No block
direct pressure for 5 minutes will be held at the site of the where the local anesthetic was applied to mimic the application of the block.
Other Name: Placebo Group
Active Comparator: Group A- Paravertebral block
Participants randodmized to this arm will have a local anesthetic (Bupivicaine 0.5% without epinephrine) injection and will be given a paravetebral block into the T10 paravertebral space..
Drug: Group A-Paravertebral block
Bupivicaine 0.5% without epinephrine (100mg)20cc will be injected into the T10 paravertebral space. Active Group
Other Name: Group A-Paravertebral block Active Group

Primary Outcome Measures :
  1. Pain Score [ Time Frame: 24 hours ]
    post-operative pain will be measured by the Visual Analog Scale (VAS.

Secondary Outcome Measures :
  1. Opiod Use [ Time Frame: 24 hours ]
    All patients will receive the same post-operative pain control, which does not deviate from our standard protocol for patients receiving PCNL. All patients will be immediately given a PCA in recovery. Patients allergic to morphine/dilaudid will be given a narcoticopioid substitute (that will be converted to morphine equivalents for the purpose of the study). Nurses will be allowed to administer IV boluses of morphine PRN for inadequate pain control. If four boluses did not yield adequate analgesia, fentayl 50mcg will be used until adequate pain control is achieved.

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Consent to undergo percutaneous nephrolithotomy
  • Between the ages of 18 and 75
  • Able to consent, fill out study documents, and complete all study procedures and follow-up visits

Exclusion Criteria:

  • Will have bilateral percutaneous nephrolithotomy
  • Have an infection at the site of the proposed block
  • Have anatomy that prevents ability to perform block
  • Have a coagulopathy which may increase their chances of bleeding from the block
  • Have a known allergy to local anesthetics
  • Are unable to fill out the VAS scale due to physical or mental conditions
  • Are unable to use a patient controlled analgesia (PCA) device due to physical or mental conditions
  • Are pregnant

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01480102

Contact: Thomas Turk, MD 708-216-8152
Contact: Mary J Tulke, RN 708-216-2067

United States, Illinois
Loyola University Medical Center Recruiting
Maywood, Illinois, United States, 60153
Contact: Thomas Turk, MD    708-216-8152   
Sponsors and Collaborators
Loyola University

Responsible Party: Thomas Turk, Professor, Loyola University Identifier: NCT01480102     History of Changes
Other Study ID Numbers: 203648
First Posted: November 28, 2011    Key Record Dates
Last Update Posted: March 30, 2017
Last Verified: March 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by Thomas Turk, Loyola University:
Percutaneous nephrolithotomy
Paravertebral block

Additional relevant MeSH terms:
Pain, Postoperative
Neurologic Manifestations
Nervous System Diseases
Postoperative Complications
Pathologic Processes
Signs and Symptoms
Anesthetics, Local
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents