title: Thoracic paravertebral block for nephrectomy: a randomized, controlled, observer-blinded study.
abstract: OBJECTIVE
  This study evaluated whether adding a preoperative single thoracic paravertebral block (TPVB) to intravenous patient-controlled analgesia (IV PCA) would improve postoperative analgesia compared with using IV PCA alone in patients undergoing nephrectomy.
  
  
  METHODS
  Prospective, randomized, controlled, observer-blinded trial.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Thirty-four adult patients undergoing elective open nephrectomy.
  
  
  METHODS
  The patients were randomized to receive a TPVB plus IV PCA (group T) or IV PCA alone (group C). A single 18-mL injection of 0.75% ropivacaine was administered preoperatively under ultrasound guidance; fentanyl was used for IV PCA. Each patient's postoperative pain score based on a verbal numerical rating scale, postoperative fentanyl consumption, inspiratory volume by incentive spirometry, and complications were evaluated at 1, 3, 6, 12, and 24 hours after surgery. Changes in heart rate (HR), systolic arterial pressure (SAP), and mean arterial pressure (MAP) were evaluated following skin incision.
  
  
  RESULTS
  The postoperative pain score and fentanyl consumption were significantly lower in group T than in group C at all time points up to 24 hours after surgery. The postoperative inspiratory volumes were not significantly different. The changes in HR were similar, while the increases in SAP and MAP after skin incision were lower in group T than in group C.
  
  
  CONCLUSIONS
  A preoperative single TPVB improved postoperative analgesia by reducing the postoperative pain score and fentanyl consumption in patients undergoing nephrectomy.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
authors.forename: Ji Seok
authors.initials: JS
authors.lastname: Baik
authors.forename: Ah-Young
authors.initials: AY
authors.lastname: Oh
authors.forename: Chan Woo
authors.initials: CW
authors.lastname: Cho
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Shin
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Han
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Ryu
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002292:Carcinoma, Renal Cell / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl
keywords: Fentanyl; Nephrectomy; Patient-Controlled Analgesia; Postoperative Pain; Pre-Emptive Analgesia; Thoracic Paravertebral Block