Comparative analysis of the paravertebral block and epidural anesthesia in the complex of anesthetic support for laparoscopic kidney surgery: open randomized clinical study
- Authors: Lapkina I.V.1, Ovechkin A.M.1, Alekseeva T.M.1, Kozlov V.V.1, Bezrukov E.A.1, Slusarenko R.I.1
-
Affiliations:
- Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 17, No 1 (2023)
- Pages: 25-38
- Section: Original articles
- URL: https://journals.rcsi.science/1993-6508/article/view/131736
- DOI: https://doi.org/10.17816/RA217696
- ID: 131736
Cite item
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.
Full Text
##article.viewOnOriginalSite##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, MoscowAlexey 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, MoscowTatyana 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, MoscowVasily 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, MoscowEvgenii 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, MoscowRoman I. Slusarenko
Sechenov First Moscow State Medical University (Sechenov University)
Email: slusarenco.roman@gmail.com
SPIN-code: 4051-0916
urologist
Russian Federation, MoscowReferences
- Sountoulides PG, Kaufmann OG, Kaplan AG, et al. Laparoscopic renal surgery. Minerva Chir. 2009;64(4):373–394.
- Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. BMJ. 2000;321(7275):1493–1497. doi: 10.1136/bmj.321.7275.1493
- Detterbeck FC. Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg. 2005;80(4):1550–1559. doi: 10.1016/j.athoracsur.2004.11.051
- Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: A literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003;26(1):1–49. doi: 10.1007/s10143-002-0224-y
- Aufforth R, Jain J, Morreale J, et al. Paravertebral blocks in breast cancer surgery: Is there a difference in postoperative pain, nausea, and vomiting? Ann Surg Oncol. 2012;19(2):548–552. doi: 10.1245/s10434-011-1899-5
- Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy — A systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96(4):418–426. doi: 10.1093/bja/ael020
- Haager B, Schmid D, Eschbach J, et al. Regional versus systemic analgesia in video-assisted thoracoscopic lobectomy: A retrospective analysis. BMC Anesthesiol. 2019;19(1):34–36. doi: 10.1186/s12871-019-0851-2
- Naja MZ, Ziade MF, Lönnqvist PA. General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: A prospective, randomized clinical trial. Eur J Anaesthesiol. 2004;21(6):489–495. doi: 10.1017/S026502150400612X
- Thavaneswaran P, Rudkin GE, Cooter RD, et al. Paravertebral block for anesthesia: A systematic review. Anesth Analg. 2010;110(6):1740–1744. doi: 10.1213/ANE.0b013e3181da82c8
- Batra RK, Krishnan K, Agarwal A. Paravertebral Block. J Anaesthesiol Clin Pharmacol. 2011;27(1):5–11. doi: 10.4103/0970-9185.76608
- Baik JS, Oh AY, Cho CW, et al. Thoracic paravertebral block for nephrectomy: A randomized, controlled, observer-blinded study. Pain Med. 2014;15(5):850–856. doi: 10.1111/pme.12320
- Borle AP, Chhabra A, Subramaniam R, et al. Analgesic efficacy of paravertebral bupivacaine during percutaneous nephrolithotomy: An observer blinded, randomized controlled trial. J Endourol. 2014;28(9):1085–1090. doi: 10.1089/end.2014.0179
- Tan X, Fu D, Feng W, Zheng X. The analgesic efficacy of paravertebral block for percutaneous nephrolithotomy: A meta-analysis of randomized controlled studies. Medicine (Baltimore). 2019;98(48):56–62. doi: 10.1097/MD.0000000000017967
- Copik M, Bialka S, Daszkiewicz A, Misiolek H. Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial. Eur J Anaesthesiol. 2017;34(9):596–601. doi: 10.1097/EJA.0000000000000673
- Ak K, Gursoy S, Duger C, et al. Thoracic paravertebral block for postoperative pain management in percutaneous nephrolithotomy patients: A randomized controlled clinical trial. Med Princ Pract. 2013;22(3):229–233. doi: 10.1159/000345381
- Elbealy E, Rashwan D, Kassim SA, Abbas S. A comparison of the effects of epidural anesthesia, lumbar paravertebral block and general anesthesia in percutaneous nephrolithotomy. J Med Sci. 2008;8(2):170–176. doi: 10.3923/jms.2008.170.176
- Moawad HE, Mousa SA, El-Hefnawy AS. Single-dose paravertebral blockade versus epidural blockade for pain relief after open renal surgery: A prospective randomized study. Saudi J Anaesth. 2013;7(1):61–67. doi: 10.4103/1658-354X.109814
- Gautam SS, Das P, Agarwal A, et al. Comparative evaluation of continuous thoracic paravertebral block and thoracic epidural analgesia techniques for post-operative pain relief in patients undergoing open nephrectomy: A prospective, randomized, single-blind study. Anesth Essays Res. 2017;11(2):359. doi: 10.4103/0259-1162.194559
- Aydin G, Aydin O. The efficacy of ultrasound-guided paravertebral block in laparoscopic cholecystectomy. Medicina (Kaunas). 2018;54(5):1–8. doi: 10.3390/MEDICINA54050075
- Agarwal A, Batra R, Chhabra A, et al. The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy. Saudi J Anaesth. 2012;6(4):344–349. doi: 10.4103/1658-354X.105860
- Tang T, Lang F, Gao S, Chen L. Effect of combined thoracic paravertebral block and general anesthesia vs general anesthesia alone on postoperative stress and pain in patients undergoing laparoscopic radical nephrectomy. Med Sci Monit. 2021;27:56–67. doi: 10.12659/MSM.933623
- Ardon AE, Lee J, Franco CD, et al. Paravertebral block: Anatomy and relevant safety issues. Korean J Anesthesiol. 2020;73(5):394–400. doi: 10.4097/kja.20065
- Rafmell DP, Nil DM, Viskoumi KM. Regionarnaya anesteziya: samoe neobkhodimoe v anesteziologii. Transl. from Engl. 2nd ed. Zil’ber AP, Mal’tsev VV, editors. Moscow: MEDpress-inform; 2008. P. 57, 149. (In Russ).
- Osipova NA, Nikoda VV. Science on pain: modern state of art. Acute and chronic pain syndromes (data on the 10th World pain congress). Russian Journal of Anaesthesiology and Reanimatology. 2003;5:4–9. (In Russ).
- Torske KE, Dyson DH. Epidural analgesia and anesthesia. Vet Clin North Am Small Anim Pract. 2000;30(4):859–874. doi: 10.1016/S0195-5616(08)70011-1
- Júnior Ade P, Erdmann TR, Santos TV, et al. Comparison between continuous thoracic epidural and paravertebral blocks for postoperative analgesia in patients undergoing thoracotomy: Systematic review. Brazilian J Anesthesiol. 2013;63(5):433–442. doi: 10.1016/j.bjane.2013.10.002
- Hutchins JL, Grandelis AJ, Kaizer AM, Jensen EH. Thoracic paravertebral block versus thoracic epidural analgesia for post-operative pain control in open pancreatic surgery: A randomized controlled trial. J Clin Anesth. 2018;48:41–45. doi: 10.1016/j.jclinane.2018.04.013
- Yenidünya O, Bircan HY, Altun D, et al. Anesthesia management with ultrasound-guided thoracic paravertebral block for donor nephrectomy: A prospective randomized study. J Clin Anesth. 2017;37:1–6. doi: 10.1016/j.jclinane.2016.10.038
Supplementary files
![](/img/style/loading.gif)