Different local anesthetic technique for postoperative analgesia in open cholecystectomy

Abstract

Background Paravertebral block is the technique of injecting a local anesthetic (LA) solution alongside the vertebral column close to the emergence of the spinal nerves. Infiltration of LAs into the surgical wound is a simple, safe, and low-cost technique for postoperative analgesia. Patients and methods Patients with physical status ASA I-II aged 20-45 years of both sexes and scheduled for an elective open cholecystectomy with subcostal incision were included in this study. Patients were classified randomly using sealed envelopes into three equal groups of 60 patients each. At the end of the surgical procedures, for all the patients of the study, a continuous wound catheter (CWC) and a continuous paravertebral catheter were inserted: group I (CWC), group II (continuous paravertebral catheter), and group III (control group). Anesthesia was induced with an intravenous fentanyl injection (1.5 µg/kg), propofol (1.5 mg/kg), followed by cis-atracurium (0.15 mg/kg), and then the patient was intubated after 3 min. Maintenance of anesthesia was by isoflurane with minimal alveolar concentration (1.5) with additional doses of cis-atracurium (0.04 mg/kg) when needed. Results A total of 120 patients were included in the study, with 40 patients randomized to each group. There were no significant differences in demographic data. For mean arterial blood pressure, heart rate, and respiratory rate, there were no significant differences between the groups, except 30 min after extubation, when there was a significant increase in group III compared with the other two groups. For SpO 2 , there was no significant difference between the three groups. In terms of pain assessment using visual analogue scale, there was a significant decrease at all time points in the values of group II compared with the other two groups and in group I compared with group III. Conclusion We conclude that paravertebral block with a continuous infusion is more effective than a CWC infusion in postoperative pain management after surgeries with subcostal incisions, although both techniques showed a significant improvement compared with the control group.