Thoracic Paravertebral Block for Postoperative Pain Management in Patients Undergoing for Nephrectomy: A Randomised Clinical Trial

Abstract

Introduction: Pain is one of the most dreaded side effects of surgery for the patient during as well as after the surgery. Effective postoperative pain control is an essential component of the care of the surgical patient. Inadequate pain control may result in increased morbidity or mortality. Aim: To compare Thoracic Para Vertebral Block (TPVB) and IV PCA (fentanyl) and with IV PCA alone, for postoperative analgesia and also to compare intraoperative and postoperative haemodynamic changes and side effects in patients undergoing open nephrectomy. Materials and Methods: Patients were randomised into two groups, 30 patients in each group. GROUP A: Received preoperative single thoracic paravertebral block (20 mL 0.25% bupivacaine) + General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose -12 microgm, Lockout interval- 20 minutes. GROUP B: Received General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose-12 microgm, Lockout interval-20 minutes. Postoperative pain score, amount of fentanyl consumption, Demand dose and haemodynamic stability was assessed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software. The values were represented in Number (%) and Mean±SD. Results: Group A which received preoperative TPVB and IV PCA showed less analgesia, less fentanyl consumption, less demand dose and better haemodynamic stability in comparison to the Group B which received IV PCA alone (p<0.001). Conclusion: TPVB provide excellent and prolonged postoperative analgesia, significantly reduced consumption of rescue analgesia and less demand dose in the postoperative period, good opioid sparing and pre-emptive effect in patients undergoing nephrectomy as compared to iv PCA alone.

Keywords

• fentanyl
• patient controlled analgesia
• vas score