Comparative Study between Unilateral Transversus Abdominis Plane Block versus Fentanyl as Analgesic for Ureteric Shock Wave Lithotripsy

Background: Urolithiasis, a global health concern affecting 13% of men and 7% of women, is recurrently affecting 25%, emphasizing the need for prevention and follow-up care. Objective: To assess the analgesic safety and efficiency of ultrasound-guided unilateral transversus abdominis plane (TAP) block in comparison with intravenous (IV) fentanyl throughout ureteric extracorporeal shock wave lithotripsy (ESWL). Patients and methods: This prospective randomized comparative study included 50 patients divided into Group (F) who received fentanyl 1.5 micrograms per kilogram IV and Group (T) who received unilateral transversus abdominis plane block. Results: There was a statistically insignificant variance among the 2 groups in intraoperative Ramsay Sedation Scores (RSS) at 5, 10, 20, and 40 minutes; however, significant differences were observed at 15, 25, 30, and 35 minutes. In the post-anesthesia care unit (PACU), RSS values were significantly different at 10, 20, 30, but not significant at 40 minutes. Regarding pain scores evaluated by the visual analogue scale (VAS), no significant difference was found at 35 minutes intraoperatively, while significant differences were noted at 5, 10, 15, 20, 25, 30, and 40 minutes, with a highly significant difference at 10, 20, 30 minutes. In the PACU, VAS scores showed no significant difference at 20, 30, and 40 minutes. As for side effects, no significant difference was found in pruritus, while bradypnea, vomiting, and nausea were significantly more prevalent in fentanyl group. Conclusion: Both groups showed differences in sedation depth and analgesic efficacy, comparable pruritus rates, but differed in adverse effects, especially related to respiratory and gastrointestinal function.