Bilateral thoracic paravertebral block versus intraperitoneal bupivacaine for pain management after laparoscopic cholecystectomy

Abstract

Background and Objectives: The efficacy of bilateral thoracic paravertebral block (TPVB ) was compared to intraperitoneal ( IP ) bupivacaine in reducing postoperative pain following laparoscopic cholecystectomy (LC ) using a prospective randomized study design. Methods: We studied forty two patients scheduled for laparoscopic cholecystectomy. All of them received the same technique of general anaesthesia. Patients were randomly allocated into 3 equal groups, 14 patients each; Group PV received bilateral thoracic paravertebral block at T5-6 level with 25 mL of bupivacaine 0.25 % with epinephrine 1 : 200.000 on each side, Group IP received 50 mL of bupivacaine 0.25 % with epinephrine 1: 200.000 sprayed into the peritoneal cavity immediately after the pneumoperitoneum, and Group GA, received general anaesthesia only. Postoperative pain was assessed used visual analogue scale (VAS) and analgesic requirements and complications were recorded. Results: There was significant decrease in VAS, HR, MAP, and morphine consumption in groups PV & IP when compared to group GA, also there were significant prolongation in time to rescue analgesia and reduction in hospital stay in group PV and IP compared to group GA. In comparison between the 2 active groups, paravertebral block was significantly superior to intraperitoneal bupivacaine in all parameters. Conclusion: Both TPVB and IP bupivacaine are effective in reducing pain after LC. TPVB is superior to IP bupivacaine in controlling postoperative course of LC.