title: Unilateral paravertebral block compared with subarachnoid anesthesia for the management of postoperative pain syndrome after inguinal herniorrhaphy: a randomized controlled clinical trial.
abstract: Inguinal herniorrhaphy is a common surgical procedure. The aim of this investigation was to determine whether unilateral paravertebral block could provide better control of postoperative pain syndrome compared with unilateral subarachnoid block (SAB). A randomized controlled study was conducted using 50 patients with unilateral inguinal hernias. The patients were randomized to receive either paravertebral block (S group) or SAB (C group). Paravertebral block was performed by injecting a total of 20 mL of 0.5% levobupivacaine from T9 to T12 under ultrasound guidance, whereas SAB was performed by injecting 13 mg of 0.5% levobupivacaine at the L3 to L4 level. Data regarding anesthesia, hemodynamic changes, side effects, time spent in the postanesthesia care unit, the Karnofsky Performance Status, acute pain and neuropathic disturbances were recorded. Paravertebral block provided good anesthesia of the inguinal region without patient or surgeon discomfort, with better hemodynamic stability and safety and with a reduced time to discharge from the postanesthesia care unit compared with SAB. During the postsurgical and posthospital discharge follow-ups, rest and incident pain and neuropathic positive phenomena were better controlled in the S group than in the C group. The consumption of painkillers was higher in the C group than in the S group throughout the follow-up period. Paravertebral block can be considered a viable alternative to common anesthetic procedures performed for inguinal hernia repair surgery. Paravertebral block provided good management of acute postoperative pain and limited neuropathic postoperative disturbances.
authors.affiliation: Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy Department of Anesthesia and Intensive Care Unit, University of Chieti-Pescara, Chieti, Italy Department of Anesthesia and Intensive Care Unit, Hospital of Padua, University of Padua, Padua, Italy Anesthesia and Intensive Care Unit, Città della Salute e della Scienza di Torino, Turin, Italy Department of Anesthesia and Intensive Care Unit, Hospital of Cremona, Cremona, Italy Department of General Surgery, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Fusco
authors.forename: Vincenza
authors.initials: V
authors.lastname: Cofini
authors.forename: Emiliano
authors.initials: E
authors.lastname: Petrucci
authors.forename: Paolo
authors.initials: P
authors.lastname: Scimia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paladini
authors.forename: Astrid U
authors.initials: AU
authors.lastname: Behr
authors.forename: Fabio
authors.initials: F
authors.lastname: Gobbi
authors.forename: Tullio
authors.initials: T
authors.lastname: Pozone
authors.forename: Giorgio
authors.initials: G
authors.lastname: Danelli
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Marco
authors.forename: Roberto
authors.initials: R
authors.lastname: Vicentini
authors.forename: Stefano
authors.initials: S
authors.lastname: Necozione
authors.forename: Franco
authors.initials: F
authors.lastname: Marinangeli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D020644:Midline Thalamic Nuclei; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine