title: Continuous right thoracic paravertebral block following bolus initiation reduced postoperative pain after right-lobe hepatectomy: a randomized, double-blind, placebo-controlled trial.
abstract: OBJECTIVE
  We hypothesized that continuous right thoracic paravertebral block, following bolus initiation, decreases opioid consumption after right-lobe hepatectomy in patients receiving patient-controlled intravenous analgesia with sufentanil.
  
  
  METHODS
  Patients undergoing right-lobe hepatectomy with a right thoracic paravertebral catheter placed at T7 30 minutes before surgery were randomly assigned to receive through this catheter either a 10-mL bolus of 0.2% ropivacaine before emergence, followed by a continuous infusion of 6 mL/h for 24 hours (PVB group), or saline at the same scheme of administration (control group). All patients were started on patient-controlled intravenous analgesia with sufentanil in the postanesthesia care unit. The primary outcome measure was total sufentanil consumption during the first 24 postoperative hours. P = 0.05 was considered as significant. For the multiple comparisons of data at 5 different time points, the P value for the 0.05 level of significance was adjusted to 0.01.
  
  
  RESULTS
  Sixty-six patients were assessed for eligibility, and a PVB catheter was successfully placed for 48 patients. Data were analyzed on 22 patients in group PVB and 22 patients in the control group. The cumulative sufentanil consumption in the PVB group (54.3 ± 12.1 μg) at 24 postoperative hours was more than 20% less than that of the control group (68.1 ± 9.9 μg) (P < 0.001). There was also a significant difference in pain scores (numerical rating scale) between groups, where the PVB group had lower scores than did the control group at rest and with coughing for the first 24 hours (P < 0.001).
  
  
  CONCLUSIONS
  Continuous right thoracic paravertebral block, following bolus initiation, has an opioid-sparing effect on sufentanil patient-controlled intravenous analgesia for right-lobe hepatectomy patients and reduces numerical rating scale pain scores at rest and with coughing in the first 24 postoperative hours.
authors.affiliation: From the *Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; and †Department of Anesthesiology, Wuhan First Hospital, Wuhan, China; and ‡Department of Neuroscience, Baylor College of Medicine, Houston, TX.
authors.forename: Hexiang
authors.initials: H
authors.lastname: Chen
authors.forename: Zhipin
authors.initials: Z
authors.lastname: Liao
authors.forename: Yan
authors.initials: Y
authors.lastname: Fang
authors.forename: Ben
authors.initials: B
authors.lastname: Niu
authors.forename: Amber
authors.initials: A
authors.lastname: Chen
authors.forename: Fei
authors.initials: F
authors.lastname: Cao
authors.forename: Wei
authors.initials: W
authors.lastname: Mei
authors.forename: Yuke
authors.initials: Y
authors.lastname: Tian
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil