title: Anesthesia management with ultrasound-guided thoracic paravertebral block for donor nephrectomy: A prospective randomized study.
abstract: OBJECTIVE
  To determine the efficacy of ultrasound-guided thoracic paravertebral block intraoperatively and 24 hours postoperatively in patients undergoing donor nephrectomy.
  
  
  METHODS
  Prospective randomized controlled study.
  
  
  METHODS
  Private foundation university hospital; November 2014 to June 2015.
  
  
  METHODS
  Thirty-two patients undergoing donor nephrectomy (exclusion criteria: coagulation disorders, allergy to local anesthetics, and unwillingness to participate). The final study population comprised 30 patients (15 male, 15 female) randomly assigned to either Group P (paravertebral block, n=14) or Group M (morphine, n=16).
  
  
  METHODS
  In Group P, a unilateral paravertebral catheter was inserted 1 day preoperatively; on the day of surgery, a single-level unilateral paravertebral block was administered through the catheter before general anesthesia. Infusion of bupivacaine continued intraoperatively and postoperatively. Patients in Group M received only general anesthesia, and morphine patient-controlled analgesia was begun postoperatively.
  
  
  METHODS
  Intraoperative analgesic and anesthetic requirement, postoperative numerical rating scale pain scores, additional analgesic consumption during the postoperative period, and incidence of complications related to thoracic paravertebral block (TPVB) like pleural puncture, pneumothorax, epidural spread, injection into the subarachnoid space, intravascular injection, and Horner's syndrome and rate of opioid related adverse reactions like nausea and vomiting, itching, constipation, and respiratory depression.
  
  
  RESULTS
  Intraoperative remifentanil consumption was significantly higher in Group M, and postoperative morphine consumption was significantly lower in Group P (P<.001). During the first 24 hours postoperatively, the mean numerical rating scale pain scores were similar and there were no significant differences between the 2 groups. There were no statistically significant differences in the additional analgesic consumption and rate of adverse reactions between the 2 groups. We didn't detect any complication related to TPVB in group P.
  
  
  CONCLUSIONS
  Continuous thoracic paravertebral block provides good intraoperative stability with a low anesthetic requirement and reduces postoperative morphine consumption for up to 24 hours. Ultrasound guided technique enhanced the safety of TPVB and provides analgesia without major complications.
authors.affiliation: Department of Anesthesiology, Baskent University Istanbul Training and Medical Research Center, Istanbul, Turkey. Electronic address: drozlem79@gmail.com.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yenidünya
authors.affiliation: Department of General Surgery, Baskent University Istanbul Training and Medical Research Center, Istanbul, Turkey.
authors.forename: Huseyin Yuce
authors.initials: HY
authors.lastname: Bircan
authors.affiliation: Department of Anesthesiology, Baskent University Istanbul Training and Medical Research Center, Istanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Altun
authors.affiliation: Department of Radiology, Baskent University Istanbul Training and Medical Research Center, Istanbul, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Caymaz
authors.affiliation: Department of General Surgery, Baskent University Istanbul Training and Medical Research Center, Istanbul, Turkey.
authors.forename: Alp
authors.initials: A
authors.lastname: Demirag
authors.affiliation: Department of Anesthesiology, Baskent University Istanbul Training and Medical Research Center, Istanbul, Turkey.
authors.forename: Ayda
authors.initials: A
authors.lastname: Turkoz
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059925:Anatomic Landmarks; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009392:Nephrectomy / Q000009:adverse effects*; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil; D013900:Thoracic Nerves / Q000187:drug effects; D013904:Thoracic Vertebrae; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil; D002045:Bupivacaine
keywords: Donor nephrectomy; Thoracic paravertebral block; Ultrasound