Lumbar Plexus Blockade with Ropivacaine for Postoperative Pain Management in Elderly Patients Undergoing Urologic Surgeries

Abstract

Background/Aims: We evaluated the effectiveness and safety of lumbar plexus blockade with ropivacaine for postoperative pain relief in elderly patients undergoing flank incision for urological surgery. Methods: 60 urological patients (>65 years old) were chosen randomly for paravertebral lumbar blockade. Postoperatively ropivacaine was used in group I (n = 30) and bupivacaine was administered in group II (n = 30) for lumbar plexus blockade. Heart rates, systolic and diastolic blood pressures, peripheral oxygen saturations, analgesia levels with visual analogue scales (VAS) were measured postoperatively at 5 and 30 min and 1, 3, 6, 8,and 12 h. Patient satisfaction scores and complications were recorded. Results: The hemodynamic parameters of the groups were in the normal ranges (p > 0.05). VAS were significantly decreased at 60 min in both groups (p < 0.05) and no important increase was observed during the first 8 h (p > 0.05). After the 8-hour measurement, analgesic was given to 7 patients in group I and 6 patients in group II (p < 0.05). There were no complications (p > 0.05). Patient satisfaction scores were found to be higher for all patients (p > 0.05). Conclusion: In elderly patients, lumbar plexus blockade with ropivacaine can be a simple, safe and effective analgesic technique especially in the early postoperative period after urologic surgeries with flank incision.

Analgesic Efficacy of Paravertebral Bupivacaine During Percutaneous Nephrolithotomy: An Observer Blinded, Randomized Controlled Trial

“…13 Elbealy and colleagues 9 provided surgical anesthesia for PCNL by inserting a lumbar PVB (L1-2 level) catheter and administering titrated doses of 0.5% bupivacaine up to a maximum of 35 mL. The catheter was removed after the procedure, and PCA morphine started.…”

A dose reduction study of local anesthetic with addition of dexmedetomidine on postoperative epidural analgesia after total knee arthroplasty

“…Using only local anesthetics at effective doses raises concerns about adverse events, such as hypotension, bradycardia, motor weakness, and elevation in block level [22]. Opioid combinations may not provide satisfactory results, as they are associated with respiratory depression, nausea, vomiting and pruritus [6,22]. Dexmedetomidine is a new opioid-sparing adjuvant to epidural administration.…”

“…The use of epidural analgesia is the preferred technique of analgesia in many European countries for total knee arthroplasty, as revealed by a declarative European survey [4]. Epidural techniques are commonly used in postoperative analgesia for elderly patients, with the combination of a local anesthetic and an opioid being preferred [5,6]. However, the occurrence of serious adverse effects (eg, hypotension, respiratory depression, deep bradycardia) and unwanted adverse events (eg, nausea, vomiting, motor block) with these analgesic regimens make it necessary to continue research about different and more optimal analgesia methods [6,7].…”

“…Epidural techniques are commonly used in postoperative analgesia for elderly patients, with the combination of a local anesthetic and an opioid being preferred [5,6]. However, the occurrence of serious adverse effects (eg, hypotension, respiratory depression, deep bradycardia) and unwanted adverse events (eg, nausea, vomiting, motor block) with these analgesic regimens make it necessary to continue research about different and more optimal analgesia methods [6,7]. The a-2 agonists, particularly the combination of clonidine with local anesthetics administered via the epidural or spinal route, have been found to be effective in pain management [8][9][10].…”

Safety of opioid patch initiation in Australian residential aged care

“…In older (greater than 65 years of age) patients undergoing urological surgery via a flank incision, paravertebral blockade of the lumbar plexus using either ropivacaine or bupivacaine has been shown to provide good analgesia with no changes in the patients' heart rate or blood pressure (Akin et al, 2005 Level II).…”