Efficacy of thoracic paravertebral block combined with patient-controlled intravenous analgesia for postoperative analgesia in patients after laparoscopic nephrectomy

Abstract

Objective To evaluate whether adding a single thoracic paravertebral block (TPVB) to patient-controlled intravenous analgesia (PCIA) would improve postoperative analgesia compared with PCIA alone in patients after laparoscopic nephrectomy. Methods Sixty patients undergoing laparoscopic nephrectomy, were randomly divided into combined analgesia group and PCIA group. The patients were treated with TPVB combined with PCIA in combined analgesia group, and PCIA alone in PCIA group. 0.375% ropivacaine 15 ml was injected into paravertebral space between T10 and T11 by ultrasound guidance. PCIA contained sufentanil 100 g plus ondansetron 16 mg diluted to 100 ml with normal saline, background dosage 2 ml/h, locking time 15 min. The resting and movement NRS and sufentanil consumption were recorded at 1, 3, 6, 12 and 24 h after the surgery. The forced vital capacity (FVC) was assessed at 1, 3, 6, 12 and 24 h after the surgery. The complications were observed within 24 hours. Results The resting NRS and sufentanil consumption of patients in combined analgesia group were lower than those in patient-controlled intravenous analgesia group at all time points after the surgery (P<0.05). No serious complications such as nausea, vomiting and intravertebral block were found in the two groups. The FVC of patients was significantly higher, movement NRS was lower in combined analgesia group than those in patient-controlled intravenous analgesia group at all time points after the surgery (P<0.05). Conclusion Adding a single thoracic paravertebral block (TPVB) to postoperative intravenous patient-controlled analgesia can significantly reduce the resting and movement pain score, reduce opioid dosage and increase lung capacity in patients after laparoscopic nephrectomy. Key words: Nerve block; Analgesia, patient-controlled; Laparoscopes; Nephrectomy