Unilateral Paravertebral Block: An Alternative to Conventional Spinal Anaesthesia for Unilateral Uncomplicated Inguinal Hernia Repair

Abstract

Introduction: Inguinal hernia repair can be performed under general anaesthesia or various regional anaesthesia techniques like spinal, epidural or nerve blocks like hernia block or Paravertebral Block (PVB). Though Spinal Anaesthesia (SA) is a preferred technique in many centres, PVB has regained interest in the field as a technique of anaesthesia and/or postoperative analgesia for many surgeries. Aim: To compare paravertebral block and conventional spinal anaesthesia with respect to onset and duration of blockage, duration of postoperative analgesia, intraoperative haemodynamic changes and postoperative complications in patients undergoing unilateral inguinal hernia repair. Materials and Methods: This study is a prospective comparative study conducted at BJ Medical College and Civil Hospital Ahmedabad, Gujarat, India. Fifty Male patients, aged between 18 to 60 years and ASA Status I and II undergoing elective unilateral uncomplicated inguinal hernia surgery was randomly allocated into one of the two groups i.e., PVB and SA. Time required to perform the procedure, time for onset and duration of blockage, duration of postoperative analgesia, haemodynamic changes and postoperative complications were noted in both the groups. Results: Procedure time for PVB was 16.30±2.41 minutes and for SA it was 3.32±0.74 minutes. Onset of sensory effect was within 5.3 minutes and 4.5 minutes in PVB group and SA group respectively. Time to reach surgical anaesthesia was 14.5 minutes in PVB group and 6.6 minutes in SA group. Duration of postoperative analgesia was 370.8 minutes in PVB group and 212.7 minutes in SA group. There were minute haemodynamic changes in SA group, while patients in PVB group were haemodynamically stable. Postoperative complications like nausea, vomiting, hypotension, bradycardia and urinary retention were reported in SA group and not in PVB group. Conclusion: Paravertebral block has got advantages over spinal anaesthesia in terms of intraoperative haemodynamic stability, prolonged postoperative analgesia and less postoperative complications. Time required to perform PVB is more than that for SA because PVB is needed to be given at multiple levels.

Keywords

• direct trauma
• nerve block
• regional