Effects of paravertebral block and intravenous analgesic methods on postoperative pain management and opioid consumption in laparoscopic cholecystectomies
Levent Gündost1
, Kemalettin Koltka2, Nükhet Sivrikoz2, Özlem Turhan2, Dilek Hündür2, Hacer Ayşen Yavru2, Emre Çamcı2
1Department of Anesthesiology and Reanimation, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Turkish Republic Of Northern Cyprus
2Department of Anaesthesiology and Reanimation, İstanbul University Istanbul Medical Faculty, İstanbul, Turkey
Keywords: Fentanyl, laparoscopic cholecystectomy; paravertebral block; tramadol; visual analog scale.
Abstract
Objectives: The aim of this study was to evaluate the efficiency of a thoracic paravertebral block (TPVB) for postoperative analgesia in cases of a laparoscopic cholecystectomy performed under general anesthesia.
Methods: A total of 78 patients aged 18–70 years, with an American Society of Anesthesiologists classification of I-III who were to undergo an elective laparoscopic cholecystectomy were enrolled. The patients were randomly separated into 2 groups: Group 1 (38 patients) received a TPVB performed unilaterally at T6 before surgery and Group 2 (40 patients) received only general anesthesia. Postoperatively, both groups received patient-controlled analgesia with an infusion pump. Visual analog scale (VAS) scores at rest and with movement were recorded during the first 24 hours after surgery. Tramadol consumption during the first 24 hours, nausea and vomiting rate, time to first passage of bowel gas and defecation, nutrition, mobilization, and discharge were also noted.
Results: The patients who received an ultrasonography-guided TPVB had significantly lower postoperative VAS scores at rest and on movement at 4, 6, 12,18, and 24 hours and significantly lower levels of postoperative tramadol consumption. It was observed that 77.5% of the patients in Group 2 needed at least 1 dose of additional fentanyl intraoperatively. Group 2 had a significantly higher vomiting rate and it was observed that the time of first bowel gas and defecation, nutrition, and mobilization was later. There was no significant difference between groups in the discharge time.
Conclusion: Preoperatively performed TPVB provided efficient analgesia after a laparoscopic cholecystectomy. A TPVB can also reduce perioperative and postoperative opioid requirements.