Ultrasound-guided regional anesthesia techniques stand out as an effective analgesia
method in patients undergoing robotic-assisted partial nephrectomy (RAPN). In recent
years, one of the newly defined plane blocks under ultrasound guidance, the Erector Spina
Plane (ESP) Block, has become a notable alternative in postoperative pain management
(4-6). The ESP block is applied at the level of the spinous process of the T8 vertebra,
providing a wide sensory block in the dermatomes from T5 to T12. This technique is
performed intraoperatively when the patients are in the lateral decubitus position under
general anesthesia, using an ultrasound-guided linear probe. In this study, the effects
of the ESP block applied to provide intraoperative and postoperative analgesia in
patients undergoing robotic-assisted partial nephrectomy on postoperative pain control
will be evaluated. The effectiveness of the ESP block will be comprehensively analyzed in
terms of parameters such as reducing pain levels, decreasing analgesic use, increasing
patient comfort, and accelerating the postoperative recovery process. Within the scope of
this prospective study, general anesthesia induction will be performed using propofol and
rocuronium by standard protocols, and anesthesia maintenance will be achieved with a 4-6%
combination of desflurane-O₂, remifentanil, and rocuronium intravenous infusion. All
procedures will be conducted within an observational clinical research protocol
framework, and patients will not be subjected to any methods other than routine
practices. Before the study begins, patients will be thoroughly informed, and their
written consent will be obtained. The study is planned to start in April 2025.
The patient groups that will not be included in the study are as follows:
Patients classified as ASA III or IV,
Patients with cardiopulmonary difficulties,
Patients who have previously been diagnosed with diabetes,
Conditions requiring emergency surgery,
Patients who refuse to participate in the study,
Individuals with contraindications for general anesthesia,
Patients with less than 50 kg or more than 110 kg. Patients will be placed in the
lateral decubitus position during the surgical procedure, and the surgical site will
be prepared under sterile conditions. The Erector Spina Plan (ESP) block will be
performed under ultrasound guidance as usual, using a Stimuplex block needle
(30-degree angled, 21Gx4", 0.80x100) for this purpose. The block procedure will be
performed at the level of the transverse process of the T8 vertebra. Throughout the
surgical procedure, vital parameters (systolic, diastolic, and mean arterial
pressure, heart rate, and SpO₂) will be regularly recorded at five-minute intervals.
The amount of remifentanil used according to analgesic requirements will be
systematically recorded during the intraoperative period. The patients' pain levels
and analgesic needs will be assessed in the postoperative period at 1, 12, and 24
hours. In addition, the amount of morphine consumed and the need for additional
analgesics based on postoperative analgesia requirements will be recorded in detail
in both groups. Postoperative pain management will be provided using a
patient-controlled analgesia (PCA) device by routine protocols. The PCA device
offers effective and reliable pain control by allowing patients to meet their
analgesic needs on an individual level. Patients will undergo robotic-assisted
partial nephrectomy, and by the surgical procedure, postoperative pain management
will be monitored for 24 hours, with potential complications being meticulously
recorded. Postoperative pain levels will be assessed in patients both at rest and
during coughing using a 0-10 Visual Analog Scale (VAS). When the pain score exceeds
3/10, 1000 mg of intravenous paracetamol will be administered as a rescue analgesic.
The time of the patients' first mobilization will be recorded, and the satisfaction
level of both the surgeon and the patient during the postoperative period will be
rated as 1 (Excellent), 2 (Good), and 3 (Poor). Additionally, the presence of side
effects such as nausea and vomiting will also be carefully recorded. Before the
study, a power analysis was conducted within the framework of the central
hypothesis, based on the postoperative pain rates in both groups, using the G Power
(3.1.9.7 Franz Faul, Universität Kiel, Germany) program. According to data obtained
from retrospective studies (6), the average morphine consumption in the group where
the ESP block was applied was determined to be 16 mg. Based on the assumption that a
30% difference is clinically significant according to the unpaired t-test, a minimum
of 38 patients is required for each group. However, 46 patients will be included to
increase the evidence for the study.
With this calculation, the power of the study has been determined to be 0.95 and the
significance level (α) to be 0.05. The normality of the data will be evaluated using the
Shapiro-Wilk test, and homogeneity will be assessed using the Levene test. For data
showing a normal distribution, an independent t-test will be used; for data that do not
follow a normal distribution or are not homogeneous, the Mann-Whitney U test will be
used; and for categorical variables, the Chi-square test will be used. The statistical
significance level will be accepted as p<0.05, and all analyses will be conducted using
the Windows-compatible JAMOVI (version 2.6.19) software.
