Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial


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Abstract

BACKGROUNDThoracic paravertebral block (ThPVB) combined with general anaesthesia is used in thoracic and general surgery. It provides effective analgesia, reduces surgical stress response and the incidence of chronic postoperative pain.OBJECTIVETo assess the efficacy of ThPVB in reducing opioid requirements and decreasing the intensity of pain after renal surgery.DESIGNA randomised, open label study.SETTINGA single university hospital. Study conducted from August 2013 to February 2014.PARTICIPANTSIn total, 68 patients scheduled for elective renal surgery (open nephrectomy or open nephron-sparing surgery).INTERVENTIONSPreoperative ThPVB with 0.5% bupivacaine combined with general anaesthesia, followed by postoperative oxycodone combined with nonopioid analgesics as rescue drugs. Follow-up period: 48 h.MAIN OUTCOME MEASURESTotal dose of postoperative oxycodone required, pain intensity, occurrence of opioid related adverse events, ThPVB-related adverse events and patient satisfaction.RESULTSA total of 68 patients were randomised into two groups and, of these, 10 were subsequently excluded from analysis. Patients in group paravertebral block (PVB; n = 27) had general anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n = 31) formed a control group receiving general anaesthesia only. Compared with patients in group GEN, patients who received ThPVB required 39% less i.v. oxycodone over the first 48 h and had less pain at rest (P < 0.01) throughout the first 24 h. Group PVB patients also experienced fewer opioid-related adverse events and were less sedated during the first 12 postoperative hours. Patients in the PVB group had higher satisfaction scores at 48 h compared with the control group. There were no serious adverse events.CONCLUSIONIn our study, preoperative ThPVB was an effective part of a multimodal analgesia regimen for reducing opioid consumption and pain intensity. Methods and drugs used in both groups were well tolerated with no serious adverse events. Compared with the control group, patients in the ThPVB group reported increased satisfaction.TRIAL REGISTRATIONClinical Trials NCT02840526.

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