Single-dose paravertebral blockade versus epidural blockade for pain relief after open renal surgery: A prospective randomized study

Abstract

Background:Paravertebral block (PVB) has been an established technique for providing analgesia to the chest and abdomen. We conducted the current study to compare single-dose PVB versus single-dose epidural blockade (EP) for pain relief after renal surgery.Methods:Eighty patients scheduled for renal surgery were randomly assigned into two groups according to the analgesic technique, PVB group or EP group. General anesthesia was induced for all patients. Postoperative pain was assessed over 24 h using 10-cm visual analog scale (VAS). Postoperative total pethidine consumption was recorded. Any postoperative events, such as nausea, vomiting, shivering, or respiratory complications, were recorded. Hemodynamics and blood gasometry were also recorded.Results:EP group showed significant decrease of both heart rate and mean blood pressure at most of the operative periods when compared with PVB group. There was no difference in total rescue analgesic consumption. Postoperative VAS showed no significant difference between the studied groups. Postoperative events were comparable in both the groups.Conclusion:Single injection PVB resulted in similar analgesia but greater hemodynamic stability than epidural analgesia in patients undergoing renal surgery, therefore this technique may be recommended for patients with coexisting circulatory disease.

Effect of Dexmedetomidine Versus Nalbuphine as an Adjuvant on Paravertebral Block to Manage Postoperative Pain After Mastectomies

“…However, it was managed effectively with boluses of ephedrine, atropine, and changing the depth of anesthesia without any morbidity. Our study was also consistent with the study of Hazem et al ( 23 ) in hemodynamics. No intraoperative fentanyl required in the three study groups, indicating the adequacy of analgesia produced by TPVB, which was consistent with Moller et al ( 24 ) and Mohta et al ( 25 ).…”

“…Opiate receptors stimulation on the central nervous system neurons leads to suppression of intracellular adenylyl cyclase, an opening of potassium channels, and closing of the calcium channels. This results in hyperpolarization of the cell membrane potential and suppression of action potential spread of ascending pain pathways ( 23 ). No statistically significant differences were found among the three groups relating to demographic data and operative features.…”

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

“…Some of these studies used PVB as a proper anesthetic tool for patients underwent lithotripsy ,microwave ablation of kidney tumors or percutaneous nephrolithotomy [4,5&6]. Others compare the analgesic efficacy of PVB versus epidural block in nephrectomy and intravenous patient controlled analgesia [7,8].…”

Analgesic Benefits of Ultrasound-Guided Thoraco-Abdominal Wall Peripheral Nerve Blocks

“…In 2014, Baik and colleagues looked at a single shot thoracic paravertebral block with IV PCA versus IV PCA alone and found that pain scores and fentanyl consumption were significantly lower in the paravertebral group [11]. Moawad et al compared paravertebral block and general anesthesia with epidural and general anesthesia in patients undergoing open renal surgery and found that paravertebral blockade has similar analgesic outcomes but is associated with greater hemodynamic stability than epidural anesthesia [12].…”

“…Epidurals require close management of perioperative anticoagulation and can be associated with hypotension, dural puncture, and high failure rates. Richardson et al compared thoracic paravertebral infusions with epidural infusions in patients undergoing thoracotomies [12]. The infusions were initiated prior to incision and were continued into the post-operative period and all patients received multimodal analgesia consisting of perioperative opioids and NSAIDS.…”