title: The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy.
abstract: BACKGROUND
  Paravertebral block is a popular regional anesthetic technique used for perioperative analgesia in multiple surgical procedures. There are very few randomized trials of its use in laparoscopic cholecystectomy in medical literature. This study was aimed at assessing its efficacy and opioid-sparing potential in this surgery.
  
  
  METHODS
  FIFTY PATIENTS WERE INCLUDED IN THIS PROSPECTIVE RANDOMIZED STUDY AND ALLOCATED TO TWO GROUPS: Group A (25 patients) receiving general anesthesia alone and Group B (25 patients) receiving nerve-stimulator-guided bilateral thoracic Paravertebral Block (PVB) at T6 level with 0.3 ml/kg of 0.25% bupivacaine prior to induction of general anesthesia. Intraoperative analgesia was supplemented with fentanyl (0.5 μg/kg) based on hemodynamic and clinical parameters. Postoperatively, patients in both the groups received Patient-Controlled Analgesia (PCA) morphine for the first 24 hours. The efficacy of PVB was assessed by comparing intraoperative fentanyl requirements, postoperative VAS scores at rest, and on coughing and PCA morphine consumption between the two groups.
  
  
  RESULTS
  Intraoperative supplemental fentanyl was significantly less in Group B compared to Group A (17.6 μg and 38.6 μg, respectively, P =0.001). PCA morphine requirement was significantly low in the PVB group at 2, 6, 12, and 24 hours postoperatively compared to that in Group A (4.4 mg vs 6.9 mg, 7.6 mg vs 14.2 mg, 11.6 mg vs 20.0 mg, 16.8 mg vs 27.2 mg, respectively; P <0.0001 at all intervals).
  
  
  CONCLUSIONS
  Pre-induction PVB resulted in improved analgesia for 24 hours following laparoscopic cholecystectomy in this study, along with a significant reduction in perioperative opioid consumption and opioid-related side effects.
authors.affiliation: Department of Anaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Agarwal
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Batra
authors.forename: Anjolie
authors.initials: A
authors.lastname: Chhabra
authors.forename: Rajeshwari
authors.initials: R
authors.lastname: Subramaniam
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Misra
keywords: Laparoscopic cholecystectomy; opioid-sparing effect; paravertebral block; pre-emptive analgesia