Effects Of Paravertebral Nerve Block Versus Epidural Block On Quadriceps Muscle Strength After Percutaneous Nephrolithotomy

Objective: To observe the effect of paravertebral nerve block and epidural nerve block anesthesia on quadriceps femoris muscle strength and postoperative rehabilitation in patients after percutaneous nephrolithotomy.Methods: The study subjects included 163 patients with renal calculi requiring percutaneous nephrolithotomy who were admitted to The Second Hospital of Da Lian Medical University from February 2022 to October 2022.163 patients undergoing percutaneous nephrolithotomy were randomly divided into the epidural anesthesia group(EPA group)and the paravertebral nerve block group(PNB group).81 in the EPA group and 82 in the PNB group.Patients in the EPA group were punctured at the T11 and T12 spaces,and 7 - 10 ml of 0.5% ropivacaine was injected into the epidural space.PNB group received T11-T12 paravertebral nerve block with 0.5% ropivacaine 15-20 ml under ultrasound guidance before surgery.The bilateral quadriceps muscle strength grade and knee range of motion was observed and recorded 1 hour after anesthesia,2 hours after anesthesia,3 hours,and 24 hours after anesthesia in both groups.Secondary observation recorded the time from the start of anesthesia to the first walking,the time of sensory plane recovery,the amount of additional analgesics during and after surgery,nausea and vomiting,length of hospital stay,VAS score at half an hour after anesthesia,1 hour after anesthesia,2 hours after anesthesia,and mean arterial pressure,heart rate,and oxygen saturation before the start of surgery,half an hour after anesthesia,and 1 hour after anesthesia.Results: One patient in the EPA group was changed to general anesthesia due to unstable circulation after anesthesia and was not included in the analysis;two patients in the PNB group were not included in the analysis because the anesthesia plane did not meet the surgical requirements.Therefore,a total of 80 patients in the EPA group and 80 patients in the PNB group were finally included in the analysis.There were no significant differences in age,sex,operative time,blood loss,or ASA score between the two groups.There was no significant difference in lower limb muscle strength and knee range of motion before anesthesia between the two groups(P > 0.05).The affected side quadriceps femoris muscle strength grade and knee range of motion decreased 1 hour after anesthesia,2 hours after anesthesia,and 3 hours after anesthesia in both groups.However,the affected side quadriceps femoris muscle strength grade and knee range of motion in the PNB group were higher than those in the EPA group at 1 hour after anesthesia,2 hours after anesthesia,and 3 hours after anesthesia(P < 0.05),with statistically significant differences.Compared with the preoperative results,the quadriceps muscle strength and knee motion on the intact side of patients in the EPA group decreased significantly.Still,the quadriceps muscle strength and knee motion on the intact side of patients in the PNB group did not decrease.There was no significant difference in bilateral quadriceps femoris muscle strength and knee range of motion between the two groups 24 hours after surgery(P > 0.05).The time from the start of anesthesia to the first walk was shorter(P < 0.05),and the sensory plane recovery was more(P < 0.05)in the PNB group than in the EPA group.The amount of additional analgesics during surgery was more in the PNB group than in the EPA group(P < 0.05),but there was no significant difference in the amount of analgesics after surgery(P > 0.05).There was no significant difference in the frequency of postoperative nausea and vomiting between the two groups.There was no significant difference in the length of hospital stay between the two groups.The VAS score in the PNB group was higher than that in the EPA group at half an hour after anesthesia(P < 0.05),but there was no significant difference in the VAS score between the PNB group and the EPA group at half an hour after anesthesia,1 hour after anesthesia and 2 hours after anesthesia(P > 0.05).There was no significant difference in heart rate and oxygen saturation between the two groups at half an hour after anesthesia and 1 hour after anesthesia(P > 0.05).Conclusion: Compared with epidural anesthesia,paravertebral nerve block has less effect on the quadriceps femoris in patients undergoing percutaneous nephrolithotomy,allowing patients to move earlier.Paravertebral nerve block and epidural anesthesia both have little impact on the hemodynamics of patients during surgery.The incidence of postoperative nausea and vomiting and the VAS pain score are similar.The paravertebral nerve block is an anesthesia method that can not only meet surgical anesthesia’s needs but also enhance patient recovery.