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Excerpt
We examined the effect of multiple level paravertebral block in a randomised, double blind study on postoperative pain, opioid requirement and POVN.
Material and Methods: 194 patients were eligible, 36 met exclusion criteria, 70 declined and 10 were excluded during and after the study. Paracetamol 1 gr. was given preop. Immediately before the induction of anaesthesia paravertebral block was performed (1) from C7 to Th4-5 with either Ropivacaine 5 mg/ml 5 ml at each level (R) or Saline 5 ml at each level (S). Anaesthesia was induced and maintained with propofol infusion and fentanyl. The airway was maintained with a laryngeal mask.
The anaesthetist performing the block, the anaesthetising nurse, the recovery nurse, the interviewing anaesthetist and the patient were all blinded to the type of treatment.
Postoperatively fentanyl was administered as PCA in doses of 50 μg. Pain was assessed on a numeric scale (0-10) and the occurrence of POVN noted on days 0 to 2 of surgery.
Results and Discussion: The two groups were comparable with respect to age (mean 57 years), BMI (mean 24) and type of surgery. One half of the patients had lumpectomy and axillary dissection and the other half had mastectomy and axillary dissection.
During anaesthesia the R group received 200 μg of fentanyl (median, range 100-400 μg) and the S group 350 μg (100-550 μg). In the recovery room 23 of 38 patients in the R group did NOT receive opioids; in the Saline group only 10 of 40 did not use opioid.
Conclusion: Paravertebral block provided good pain relief until the evening and fewer patients needed opioid in the PACU. A surprisingly low incidence of POVN was seen in this study.
