Opioid saving strategy: bilateral single-site thoracic paravertebral block in right lobe donor hepatectomy.
OBJECTIVE
Postoperative analgesia after hepatectomy remains a challenge, mainly because of limited therapeutic index of the conventional opioids. The aim of this study is to evaluate the efficacy of bilateral single-site thoracic paravertebral block for the management of postoperative pain following right lobe donor hepatectomy (RLDH) using a prospective, randomized and controlled study design.


METHODS
Twenty four adult patients, aged 18-50 years, ASA-I-II, of both sexes scheduled for right lobe donor hepatic resection, were enrolled in this study. Patients were randomly allocated into 2 equal groups of 12 patients each. Before induction of general anesthesia, all patients received bilateral single-site thoracic paravertebral injection at the level of T7-8 in the sitting position. Patients of Group B were injected with 25 mL of bupivacaine 0.25% with epinephrine 1:200.000 on each side. Patients of Group P were injected with 25 mL of 0.9% NaCl (placebo). General anesthesia was standardized in all patients. Postoperative pain score, analgesic requirements and the incidence of postoperative nausea and vomiting were recorded.


RESULTS
Bilateral single-site thoracic paravertebral block significantly decrease the pain visual analogue score parameters. Total morphine consumption in the first 24 hours postoperatively was decreased by more than 50% in Group B (21.76 +/- 6.8 mg compared to 44.12 +/- 9.2 mg in Group P). There was significant prolongation in time to rescue analgesia (104.08 +/- 2.04 min in Group B, and 31.5 +/- 6.14 min in Group P). Postoperative nausea and vomiting was significantly less in the active Group B when compared to the controlled Group P.


CONCLUSIONS
Bilateral single-site thoracic paravertebral block is easy, safe and efficient technique for postoperative pain management in patients undergoing right lobe donor hepatectomy.
Moussa
Ashraf A
AA
Department of Anesthesiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. ashrafmoussa91@hotmail.com
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006498:Hepatectomy; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011997:Recovery Room; D013908:Thoracotomy
D000701:Analgesics, Opioid; D009020:Morphine