The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy

Anil Agarwal, Ravinder K Batra, Anjolie Chhabra, Rajeshwari Subramaniam, Mahesh C Misra, Anil Agarwal, Ravinder K Batra, Anjolie Chhabra, Rajeshwari Subramaniam, Mahesh C Misra

Abstract

Background: Paravertebral block is a popular regional anesthetic technique used for perioperative analgesia in multiple surgical procedures. There are very few randomized trials of its use in laparoscopic cholecystectomy in medical literature. This study was aimed at assessing its efficacy and opioid-sparing potential in this surgery.

Methods: FIFTY PATIENTS WERE INCLUDED IN THIS PROSPECTIVE RANDOMIZED STUDY AND ALLOCATED TO TWO GROUPS: Group A (25 patients) receiving general anesthesia alone and Group B (25 patients) receiving nerve-stimulator-guided bilateral thoracic Paravertebral Block (PVB) at T6 level with 0.3 ml/kg of 0.25% bupivacaine prior to induction of general anesthesia. Intraoperative analgesia was supplemented with fentanyl (0.5 μg/kg) based on hemodynamic and clinical parameters. Postoperatively, patients in both the groups received Patient-Controlled Analgesia (PCA) morphine for the first 24 hours. The efficacy of PVB was assessed by comparing intraoperative fentanyl requirements, postoperative VAS scores at rest, and on coughing and PCA morphine consumption between the two groups.

Results: Intraoperative supplemental fentanyl was significantly less in Group B compared to Group A (17.6 μg and 38.6 μg, respectively, P =0.001). PCA morphine requirement was significantly low in the PVB group at 2, 6, 12, and 24 hours postoperatively compared to that in Group A (4.4 mg vs 6.9 mg, 7.6 mg vs 14.2 mg, 11.6 mg vs 20.0 mg, 16.8 mg vs 27.2 mg, respectively; P <0.0001 at all intervals).

Conclusion: Pre-induction PVB resulted in improved analgesia for 24 hours following laparoscopic cholecystectomy in this study, along with a significant reduction in perioperative opioid consumption and opioid-related side effects.

Keywords: Laparoscopic cholecystectomy; opioid-sparing effect; paravertebral block; pre-emptive analgesia.

Conflict of interest statement

Conflict of Interest: None declared

References

    1. Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167:84–96.
    1. Wills V, Hunt D. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87:273–84.
    1. Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: Characteristics and effect of intraperitoneal bupivacaine. Anesth Analg. 1995;81:379–84.
    1. Klein SM, Greengrass RA, Weltz C, Warner DS. Paravertebral somatic nerve block for outpatient inguinal expanded case report of 22 patients. Reg Anesth Pain Med. 1998;23:306–10.
    1. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg. 2000;90:1402–5.
    1. Soni AK, Conacher ID, Waller DA, Hilton CJ. Video-assisted thoracoscopic placement of paravertebral catheters.A technique for postoperative analgesia for bilateral thorascopic surgery. Br J Anaesth. 1994;72:462–4.
    1. Rowlingson JC, Rawal N. Postoperative pain guidelines – targeted to the site of surgery. Reg Anesth Pain Med. 2003;28:265–7.
    1. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: A critical assessment of the evidence. Anesthesiology. 2006;104:835–46.
    1. Hill SE, Keller RA, Smith MS, Grichnik K, White WD, D’Amico TA, et al. Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology. 2006;104:1047–53.
    1. Naja MZ, Ziade MF, Lonnqvist PA. General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: A prospective, randomized clinical trial. Eur J Anaesthesiol. 2004;21:489–95.
    1. Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesth Analg. 1996;83:1046–50.
    1. Greengrass R, O’Brien F, Lyerly K, Hardman D, Gleason D, D’Ercole F, et al. Paravertebral block for breast cancer surgery. Can J Anaesth. 1996;43:858–61.
    1. Kairaluoma PM, Bachmann MS, Rosenberg PH, Pere PJ. Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery. Anesth Analg. 2006;103:703–8.
    1. Kehlet H. Postoperative opioid sparing to hasten recovery: What are the issues? Anesthesiology. 2005;102:1083–5.
    1. Baumgarten RK, Greengrass RA, Wesen CA. Paravertebral block: The holy grail of anesthesia for hernia surgery? Anesth Analg. 2007;104:207.
    1. Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95:771–80.
    1. Wheeler LJ. Peripheral nerve stimulation end-point for thoracic paravertebral block. Br J Anaesth. 2001;86:598–9.
    1. Lang SA. The use of a nerve stimulator for thoracic paravertebral block. Anesthesiology. 2002;97:521–2.
    1. Cowie B, McGlade D, Ivanusic J, Barrington MJ. Ultrasound-guided thoracic paravertebral blockade: A cadaveric study. Anesth Analg. 2010;110:1735–9.
    1. Renes SH, Bruhn J, Gielen MJ, Scheffer GJ, van Geffen GJ. In-plane ultrasound-guided thoracic paravertebral block: A preliminary report of 36 cases with radiologic confirmation of catheter position. Reg Anesth Pain Med. 2010;35:212–6.
    1. Klein SM, Pietrobon R, Nielsen KC, Steele SM, Warner DS, Moylan JA, et al. Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy. Reg Anesth Pain Med. 2002;27:476–80.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel