Comparative analysis of the paravertebral block and epidural anesthesia in the complex of anesthetic support for laparoscopic kidney surgery: open randomized clinical study

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Abstract

BACKGROUND: Laparoscopic kidney surgery is performed mostly under general anesthesia. Regional techniques, primarily epidural anesthesia / analgesia (EA), help improve the surgical results. However, EA is often accompanied by several complications and side effects. The thoracic paravertebral block (PVB) is considered a reasonable and effective alternative.

OBJECTIVE: To conduct a comparative analysis of the effectiveness of general anesthesia (GA) + PVB, GA alone, and GA + EA in laparoscopic kidney surgery.

MATERIALS AND METHODS: An open-label randomized clinical study enrolled 180 patients who underwent laparoscopic kidney surgery. By using an online tool (https//www resource.studyrandomizer.com), the patients were divided into three groups in a 1:1:1 ratio. Group 1 (n=60) underwent surgery under GA + PVB, group 2 (n=60) under GA, and group 3 under GA + EA. In each group, the intra-, and postoperative need for opioids, pain intensity on a visual analog scale (VAS) 1, 6, 12, and 24 h after surgery, and activation time were assessed. The results of the groups were compared. The frequency and nature of complications when performing and working with PVB were studied.

RESULTS: The intraoperative need for opioids was greater in the GA group and comparable in the GA + PVB and GA + EA groups (p=0.137). The postoperative pain in the PVB group remained consistently low (VAS score ≈2 points) during the observation period. In the GA group, it reached ≈5 points after 1, 6, and 12 h and ≈4 points 24 h after the surgery; in the EA group, it was ≈4 points (1, 6, and 12 h) and ≈3 points 24 h after the surgery. The prolonged PVB in the postoperative period significantly lowered the opioid need (p=0.045) and contributed to earlier activation of the patients (p=0.001). Under ultrasound control, PVB is safe, and effective.

CONCLUSION: The study showed that PVB in the complex of anesthetic support for kidney surgery provides an effective and safe anesthesia / analgesia and can be used as an alternative to EA.

About the authors

Irina V. Lapkina

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: ilapkina81@mail.ru
ORCID iD: 0000-0001-8330-4146
SPIN-code: 1608-5127

anesthesiologist-resuscitator

Russian Federation, 8 Trubetskaya Str., 119991, Moscow

Alexey M. Ovechkin

Sechenov First Moscow State Medical University (Sechenov University)

Email: ovechkin_alexei@mail.ru
ORCID iD: 0000-0002-3453-8699
SPIN-code: 1277-9220

MD, Dr. Sci. (Med.), professor

Russian Federation, Moscow

Tatyana M. Alekseeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: altami62@rambler.ru
ORCID iD: 0000-0003-3560-873X
SPIN-code: 2644-4484

anesthesiologist-resuscitator

Russian Federation, Moscow

Vasily V. Kozlov

Sechenov First Moscow State Medical University (Sechenov University)

Email: kvv.doc@gmail.com
ORCID iD: 0000-0002-2389-3820
SPIN-code: 7703-0013
Scopus Author ID: 57191536076
ResearcherId: B-2647-2017

MD, Cand. Sci. (Med.), associate professor

Russian Federation, Moscow

Evgenii A. Bezrukov

Sechenov First Moscow State Medical University (Sechenov University)

Email: eabezrukov@rambler.ru
SPIN-code: 2208-2676

MD, Dr. Sci. (Med.), professor

Russian Federation, Moscow

Roman I. Slusarenko

Sechenov First Moscow State Medical University (Sechenov University)

Email: slusarenco.roman@gmail.com
SPIN-code: 4051-0916

urologist

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Ultrasound picture of paravertebral space verification and puncture. Note. 1 — the shadow of the spinous process of the vertebra, 2 — transverse process, 3 — costal-vertebral articulation, 4 — parietal pleura, 5 — costal-vertebral articulation, 6 — paravertebral space, 7 — needle along the longitudinal axis of scanning, 8 — ventral pleural movement.

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3. Fig. 2. The need for opioids (µg and µg/kg per min) depending on the method of anesthesia. Note. OA + ПВБ — general anesthesia combined with paravertebral blockade, OA — general anesthesia, OA + ЭА — general anesthesia combined with epidural anesthesia.

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4. Fig. 3. Intensity of pain according to VAS in subgroups. Note. ВАШ — the visually analog scale, a) — 1 hour, b) — 6 hours, c) —12 hours, d) — 24 hours after surgery.

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Copyright (c) 2023 Lapkina I.V., Ovechkin A.M., Alekseeva T.M., Kozlov V.V., Bezrukov E.A., Slusarenko R.I.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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