Paravertebral block is a proper alternative anesthesia for outpatient lithotripsy

Abstract

Context:This study evaluated the effectiveness of paravertebral block as an alternative anesthetic technique for extracorporeal shock wave lithotripsy (ESWL) procedure. A total of 50 patients with renal stones, aged 20-60 years, were randomly allocated into two groups; 25 patients in group P; received unilateral paravertebral block from T8 through L1 with injection of 5 mL 0.5% bupivacaine and 25 patients in group L; received local infiltration by bupivacaine 0.25% (2 mg/kg) into the 30 cm2 area after localizing the stones site, 10 min before the session. A total of 10 mm visual analogue scale (VAS) was used to evaluate pain every 10 min during the session. At the end of the procedure, total doses of rescue analgesia, the number of shockwaves, their power, and the total duration of shockwave treatment were recorded. After completion of the procedure, the patient was assessed for pain and nausea in the postanesthesia care unit (PACU) using the VAS. Patient's satisfaction and time needed to discharge patients to home also were recorded. Time to do the anesthetic technique was significantly higher (P < 0.001) in group-P than group-L, it was 12.7 ± 2.3 min versus 6.9 ± 1.9 min, respectively; intraoperative rescue analgesia by fentanyl was lesser (P < 0.001) in group-P than group-L, 26.7 ± 6.32 mcg versus 78.6 ± 5.41 mcg, respectively, also time interval between ends of the procedure till discharge to home was significantly higher (P < 0.001) in group-P than group-L, it was 99 ± 17 min versus 133 ± 31 min, respectively. VAS was not significant difference between both groups either intraoperative or postoperative in first hour. Patient's satisfaction was significantly higher (P < 0.05) in group-P than group-L, it was 8.8 ± 1.1 versus 6.1 ± 0.6, respectively. Adverse events were lesser, but not significant in group-P than in group-L. Two patients (8%) in group-L and one patient (4%) in the group-P experienced episodes of postoperative nausea and vomiting (PONV).Paravertebral block is an effective alternative anesthesia for outpatient lithotripsy; multiple level paravertebral blocks provide an optimal anesthetic condition, with acceptable adverse events for ESWL. And, providing proper analgesia during the procedure and in first hour after finishing of the procedure, early discharge to home and providing better patient's satisfactions.Aims:This study evaluated the effectiveness of paravertebral block as an alternative anesthetic technique for ESWL procedure.Settings and Design:Prospective open label study.Subject and Methods:A total of 50 patients with renal stones, aged 20-60 years, were randomly allocated into two groups; 25 patients in group P; received unilateral paravertebral block from T8 through L1 with injection of 5mL 0.5% bupivacaine and 25 patients in group L; received local infiltration by bupivacaine 0.25% (2 mg/kg) into the 30 cm2 area after localizing the stones site, 10 min before the session. A total of 10 mm VAS was used to evaluate pain every 10 min during the session. At the end of the procedure, total...

Thoracic paravertebral blocks in abdominal surgery – a systematic review of randomized controlled trials

“…Seven of these used a pre-specified distance beyond the transverse process as their endpoint for injection, [17][18][19][20][21][22][23] six studies reported using loss-of-resistance as their endpoint, [24][25][26][27][28][29] and four used a peripheral nerve stimulator to confirm entry into the paravertebral space. [30][31][32][33] Three studies used an ultrasound-guided technique to perform TPVB. [34][35][36] Eight studies performed TPVB injections at a single intervertebral 18 19 24-27 34 36 and 12 studies did so at multiple levels.…”

“…19 Type of surgery Nine types of surgical procedure in the included studies were identified and distributed as follows: eight studies in open inguinal herniorrhaphy 17 21-24 28 32 36 ; three studies in percutaneous nephrolithotomy (PCNL) 19 20 25 ; two studies in open renal surgery 26 34 ; two studies in laparoscopic cholecystectomy 30 31 ; and one study each in open cholecystectomy, 27 donor hepatectomy, 18 ventral wall hernia repair, 29 open major gynaecological surgery 35 and extracorporeal shock wave lithotripsy (ESWL). 33 Anaesthesia vs analgesia Nine studies used TPVB as the primary anaesthetic technique. 17 22-25 28 29 33 36 In the other 11 studies TPVB was used in the intervention group solely to provide perioperative analgesia.…”

“…Two studies compared outcomes after transversus abdominis plane (TAP) block to TPVB analgesia, 32 35 and one compared peripheral local anaesthetic infiltration to TPVB. 21 Of the nine studies using TPVB as a primary anaesthetic technique, four studies compared postoperative analgesic outcomes of TPVB to spinal anaesthesia, 22 24 28 36 and three studies compared it to general anaesthesia (GA) with systemic analgesia alone 17 23 29 One study compared TPVB to local anaesthetic infiltration alone, 33 and the last compared continuous TPVB anaesthesia and analgesia to either continuous lumbar epidural anaesthesia or GA without any supplemental technique. 25 Outcomes studied All 20 studies meeting inclusion criteria reported postoperative pain scores for varying time intervals, ranging from PACU to 12 weeks.…”

“…Agarwal et al 2012 30 Akcaboy et al 2009 22 Akcaboy et al 2010 23 Ak et al 2013 20 Baik et al 2013 34 Bhattacharya et al 2010 24 Bigler et al 1989 27 Borle et al 2014 19 Elbealy et al 2008 25 Fusco et al 2016 36 Hadzic et al 2006 17 Hanoura et al 2013 33 Kaya et al 2014 32 Klein et al 2002 21 Mandal et al 2011 28 Melnikov et al 2012 35 Moawad et al 2013 26 Moussa 2008 18 Naja et al Data analysis Meta-analysis of the data was not performed because of the significant heterogeneity in the included studies with regard to type of surgery, comparator groups and definition, measurement and reporting of analgesic outcomes. A qualitative review was undertaken instead.…”

The Effects of Paravertebral Buipivacaine-Dexmedetomidine Versus Bupivacaine-Fentanyl in Unilateral Open Renal Surgeries

“…Also EL Hennawy et al, when added dexmedetomidine to caudal Bupivacaine [10]. They found that dexmedetomidine promots the analgesic time with median 16(14-18) against bupivacaine alone median 5 (4)(5)(6). This could be explained by that dexamedetomidine had both peripheral and central analgesic effects.…”