Bayindir S. et al., 2026: . USG-guided unilateral retrolaminar block decreases pain and enhances patient comfort during extracorporeal shock wave lithotripsy: a prospective study.

Bayindir S, Yildirim K, Oner SF, Bulut OK.
Sci Rep. 2026 Mar 11;16(1):9215. doi: 10.1038/s41598-026-44086-3

The aim of this study was to evaluate the analgesic efficacy, opioid consumption, patient-operator satisfaction, and hemodynamic changes of ultrasound-guided retrolaminar block (RLB) in patients undergoing extracorporeal shock wave lithotripsy (ESWL). A total of 60 patients who underwent ESWL were divided into two groups: the RLB group (patients who received RLB 30 min before the procedure, n = 30) and the control group (patients who did not receive any block, n = 30). The primary outcome measure was the assessment of analgesic efficacy using a Visual Analog Scale (VAS). Secondary outcome measures were opioid consumption, hemodynamic variables (heart rate and mean arterial pressure), patient-operator satisfaction scores, stone-free rate, and discharge time. VAS scores were significantly lower in the RLB group (p < 0.001). Mean tramadol consumption in the control group was found to be 19.33 ± 16.64 mg, which was statistically significantly higher (p < 0.001). Patient and operator satisfaction was significantly higher in the RLB group (p < 0.001), hemodynamic stability was maintained throughout the procedure, and no block-related complications were observed. RLB provided effective analgesia and significantly reduced opioid requirements in ESWL patients. Balanced hemodynamic stability was achieved throughout the procedure, maximizing patient and operator satisfaction. Therefore, RLB is a fascial plane block that provides effective analgesia that can be applied for outpatient urological procedures such as ESWL.

Comment Hans-Göran Tiselius

Successful SWL requires adequate pain treatment so that lithotripsy can be carried out as necessary. Many methods have been described, and the unilateral retrolaminar block is another one. Obviously, the block reduces pain in a satisfactory way and accordingly gives the patient comfort during the treatment.

When I read the description and noticed how the block was completed, it seems to me like a complex procedure compared with the easy-to-handle methods with effective short-acting analgesics and sedatives that are available (e.g. alfentanil and propofol).

Nevertheless, the authors were successful with the described block and able to complete SWL.

Hans-Göran Tiselius