Evaluation of Efficacy of Ultrasound Guided Paravertebral Nerve Block as Postoperative Analgesia in Abdominal Surgeries

Abstract

Background: abdominal surgeries requires either general or regional anesthesia. Normally, general anesthesia needed for abdominal surgeries consists of a mixture of neuromuscular blockers, opioids and inhalation anesthetics. Airway control can be achieved by either endotracheal intubation or laryngeal mask. Regional anesthesia can be used alone in abdominal surgeries or in combination with general anesthesia. If regional anesthesia is used alone then effective sedation is required. Pulmonary functions impairment has a higher incidence of happening in upper abdominal surgeries than non-abdominal and non-thoracic surgeries. Intraoperative patient’s ventilation is closely related to the amount of the analgesics received give that depression of ventilation and excessive sedation should be avoided. The postoperative length of hospital stay prolongs after major gastro-intestinal surgeries due to immobility, pain and gastric immobility and that’s why postoperative pain control is essential to speed up mobility and gastro-intestinal functions. Objectives: the aim of this study was to evaluate the efficacy of ultrasound-guided paravertebral nerve block as postoperative analgesia in abdominal surgeries. Patients and Methods: a total of 64 patients were assessed for eligibility to our study, but two patients not meeting inclusion criteria and other two patients were declined to participate so four patients were excluded from the study. Sixty ASA physical status I and II patients of both sex, 18-60 years old, undergoing abdominal surgery in surgical operating theater of El-Sheikh Zayed Specialized hospital and Ain-Shams Surgery hospital, who fulfilled the inclusion criteria, had been enrolled in the study. All enrolled patients have already completed the study. Those patients were randomly allocated into two groups, 30 patients each. Results: demographic data including (age, gender and type of operation) did not show any statistically significant difference between the two studied groups with P=0.176 for the age and P =1.0 for the gender and the type of operation. Patients’ characteristics included age, sex, ASA score and type of operation. There was no significant difference in the demographic data of the two groups of the study. The mean age was 49.9 year in the Paravertebral block group, while the mean age was 47.6 year in the control group. The females’ count in group A and group B exceed the males’ amount with 20% and 6.66% respectively. According to the ASA classification, both groups have 60% classified as ASA-1 and 40% as ASA-2. In this study, four types of operations are done, Lap-cholecystectomy, Umbilical Hernia, Appendectomy and Inguinal Hernia. Conclusion: this study proved that PVB provided better postoperative pain control, fewer opioids consumption, less postoperative nausea and vomiting compared with other analgesic treatment strategies, indicating that a postoperative PVB is a feasible and an effective method for an improved postoperative pain treatment after abdominal surgery. The current study concluded that there was a significant difference in post-operative period regarding morphine consumption between PVB group and control group with the mean of total morphine consumption 0.9 and 6.9 respectively, with the P-value < 0.001.