Continuous Right Thoracic Paravertebral Block Following Bolus Initiation Reduced Postoperative Pain After Right-Lobe Hepatectomy

Abstract

Background and ObjectivesWe hypothesized that continuous right thoracic paravertebral block, following bolus initiation, decreases opioid consumption after right-lobe hepatectomy in patients receiving patient-controlled intravenous analgesia with sufentanil.MethodsPatients undergoing right-lobe hepatectomy with a right thoracic paravertebral catheter placed at T7 30 minutes before surgery were randomly assigned to receive through this catheter either a 10-mL bolus of 0.2% ropivacaine before emergence, followed by a continuous infusion of 6 mL/h for 24 hours (PVB group), or saline at the same scheme of administration (control group). All patients were started on patient-controlled intravenous analgesia with sufentanil in the postanesthesia care unit. The primary outcome measure was total sufentanil consumption during the first 24 postoperative hours. P = 0.05 was considered as significant. For the multiple comparisons of data at 5 different time points, the P value for the 0.05 level of significance was adjusted to 0.01.ResultsSixty-six patients were assessed for eligibility, and a PVB catheter was successfully placed for 48 patients. Data were analyzed on 22 patients in group PVB and 22 patients in the control group. The cumulative sufentanil consumption in the PVB group (54.3 ± 12.1 μg) at 24 postoperative hours was more than 20% less than that of the control group (68.1 ± 9.9 μg) (P < 0.001). There was also a significant difference in pain scores (numerical rating scale) between groups, where the PVB group had lower scores than did the control group at rest and with coughing for the first 24 hours (P < 0.001).ConclusionsContinuous right thoracic paravertebral block, following bolus initiation, has an opioid-sparing effect on sufentanil patient-controlled intravenous analgesia for right-lobe hepatectomy patients and reduces numerical rating scale pain scores at rest and with coughing in the first 24 postoperative hours.

WITHDRAWN: Thoracic blockade in percutaneous hepatocellular carcinoma.

“…It is one of the oldest techniques of regional anaesthesiology, described by the German gynecologist Hugo Selheim in 1905. The idea of TPVB is the administration of a topical anesthesia drug within the spinal area and the blockage of thoracic spinal nerves immediately after their exit through the intervertebral holes [9,10]. The location of the spinal space can be performed traditionally by anatomically based points or by using ultrasonography as a visualization technique.…”

Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient-controlled analgesia with thoracic paravertebral block catheter: a randomized, double-blind, controlled trial

“…However, after discontinuation of the infusion, there were no advantages evident. In another study, Chen et al 9 also reported that CI plus patient-controlled intravenous analgesia (PCIA) after hepatectomy resulted in an opioid-sparing effect and produced lower NRS scores than PCIA alone. However, contrary to our results, a previous report by Català et al showed that CI was superior to bolus doses with thoracic PVB after thoracotomies.…”

Most effective pain‐control procedure for open liver surgery: a network meta‐analysis

“…After detailed evaluation, 12 articles containing 661 patients satisfied the study recruitment criteria (Fig. , Table ).…”