Efficacy of Ultrasound-Guided Thoracic Paravertebral Block on Postoperative Quality of Recovery in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Double-Blind Placebo-Controlled Trial

Abstract

Zhirong Yan,1,* Huifen Lin,2,* Ying Yang,3 Jialin Yang,3 Xueshan Li,2 Yusheng Yao3,4 1Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Anesthesiology, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, People’s Republic of China; 3Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China; 4Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yusheng Yao, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No.134 Dongjie Street, Fuzhou, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: This study aimed to examine the effectiveness of ultrasound-guided thoracic paravertebral block on postoperative quality of recovery in patients undergoing percutaneous nephrolithotomy.Patients and Methods: In this randomized, double-blind, placebo-controlled trial, we enrolled patients scheduled for unilateral percutaneous nephrolithotomy. Patients were randomly allocated to receive thoracic paravertebral block either with 20 mL of 0.5% ropivacaine (PVB group) or an equal volume of saline (control group). The primary outcome was the quality of patient recovery at 24 h postoperatively, assessed using the 15-item Quality of Recovery scale. The secondary outcomes included the area under the curve of pain scores over time, time to first rescue analgesia, and postoperative 24 h morphine consumption.Results: We analyzed the data of 70 recruited participants. The median Quality of Recovery-15 score at 24 h postoperatively was 127 (interquartile range, 117– 133) in the PVB group, which was significantly higher than 114 (interquartile range, 109– 122) in the control group, with a median difference of 10 points (95% confidence interval, 5– 14; P< 0.001). The area under the curve of pain scores over time was lower in patients receiving thoracic PVB than in those receiving saline block (P< 0.001). The median time to first rescue analgesia in the PVB group (10.8 h, interquartile range 7.1– 22.8 h) was longer than that in the control group (1.9 h, interquartile range 0.5– 4.3 h) (P< 0.001). Similarly, the median postoperative 24-hour morphine consumption was nearly half as low in the PVB group as in the control group (P< 0.001). The occurrence of postoperative nausea and vomiting, and pruritus were significantly higher in the control group (P=0.016 and P=0.023, respectively).Conclusion: Preoperative ultrasound-guided single injection of thoracic paravertebral block with ropivacaine improved the postoperative quality of recovery and analgesia in patients undergoing percutaneous nephrolithotomy.Keywords: pain management, quality of recovery, regional anesthesia, ultrasonography

Keywords

• pain management
• quality of recovery
• regional anesthesia
• ultrasonography.