Analgesic effects of ultrasound guided paravertebral block versus transversus abdominis plane block in hepatic patients undergoing laparoscopic cholecystectomy

Abstract

Background: Several analgesic modalities after laparoscopic cholecystectomy were used in hepatic patients but with various complications. Bilateral ultrasound-guided transverse abdominis plane block (TAP) or thoracic paravertebral block (PVB) may provide safer techniques than others. The aim of this study is to delineate the more efficient and safer technique either TAP or PVB in hepatic patients. Methods: The research was conducted on sixty adult hepatic patients, ASA II or III, Child A or B, undergoing laparoscopic cholecystectomy. Patients were allocated randomly into one of two equal groups, to attain bilateral ultrasound guided either PVB (Group P) or TAP block (Group T). Group P showed significant postoperative lower pain scores using visual analogue score at 2, 4, 6 and 24 h (P < 0.01) and less intraoperative desflurane and fentanyl consumption (P < 0.001) versus group T. In addition, group P exhibited less total postoperative pethidine requirement (23.3±25.4 mg vs. 38.3±21.5 mg, P = 0.017), fewer number of patients asked for postoperative analgesia (46.7% vs. 76.7%, P value = 0.017), longer duration to first analgesic demand (20.5±5.1 h vs. 15.1±8.4 h, P = 0.021), and compared to group T respectively. Regarding liver functions and haemodynamics, both groups were comparable at different intervals.