الفهرس 
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Abstract
One of the popular and most recent urology surgeries is Percutaneous Nephrolithotomy which is considered as minimal invasive surgery what makes it first-line treatment for large, multiple, and inferior calyx renal stones. Despite being minimal invasive surgery, few studies have concentrated on the postoperative pain after PCNL.
Regarding ERAS protocol, it always provides a structured mechanism to improve the quality of care, minimize complications and improve outcomes of surgeries.
Several narcotic-related complications may be experienced, such as sedation, respiratory depression, nausea, vomiting and constipation. Recent studies have showed other modalities to decrease postoperative pain resulting from PCNL, to decrease opiates need. For example, IV Lidocaine infusion and regional nerve block techniques are among the anesthetic options available.
Intravenous lidocaine has been shown to provide good pain relief in patients who underwent surgical procedures. This effect appears to be due to a reduction of neural responses to pain by inhibiting nerve conduction. In addition, lidocaine has significant anti-inflammatory properties.
The used regional techniques include the Paravertebral Block, Intercostal Nerve block, local infiltration analgesia and ultrasound-guided Erector spinae plane block. The latest includes neural blockade and central inhibition from direct spread of local anesthetic to the paravertebral or epidural space; analgesia mediated by elevated local anesthetic plasma concentrations due to systemic absorption; immune-modulatory effects of local anesthetics; and an effect mediated through the mechano-sensory properties of thoracolumbar.
The aim of the study was investigating the research hypothesis which was that the intravenous lignocaine infusion and ESPB would improve post-operative analgesia after PCNL, and the research team would seek to determine whether one of the two techniques would be superior to the other.
We had found that Patients in IV Lidocaine infusion groups had lower hemodynamic values intra-operative and post-operative and showed significant higher values in Lidocaine serum level than ESPB group. While both groups showed same VAS in the first 4 hours, but ESPB was superior and showed lower VAS scores postoperatively. Both groups were similar in patient characteristics and had no adverse effects.
In conclusion, Single dose of IV lidocaine had an equivalent analgesic effect to ESPB in the first 4 hours post PCNL. Afterwards, ESPB had a superior analgesic effect.