Abstract
BackgroundsThe aim of this study was to evaluate the utility of unilateral single injection thoracic paravertebral block (TPVB) with and without the addition of betamethasone for the acute pain management of patient’s undergoing laparoscopic cholecystectomy (LC).MethodsEligible patients were allocated randomly to three groups: (A) general anesthesia followed by surgeon infiltration at port sites with ropivacaine (n = 48), (B) general anesthesia after single injection TPVB at right T7-8 level with ropivacaine only, Ropi_TPVB (n = 43), and (C) general anesthesia after single injection TPVB with ropivacaine plus betamethasone, Ropi_Betamet_TPVB (n = 45). Primary outcome was TPVB duration assessed by the number of dermatomes at regular intervals up to 72 hours (h). Secondary outcomes included pain scores, analgesics consumption, and perioperative functional outcomes.ResultsThe addition of betamethasone to ropivacaine in TPVB resulted in similar onset but significantly slower block regression between 4 h and 72 h as compared to ropivacaine alone (P < 0.001). When compared to the surgeon infiltration group, Ropi_TPVB and Ropi_Betamet_TPVB group had significantly lower pain scores for 24 h and 48 h, respectively, P ≤ 0.001. Both TPVB groups had less frequency of analgesics administration for 72 h, P < 0.001, and earlier mobilization, P < 0.001.ConclusionsThe addition of betamethasone to TPVB significantly prolonged block duration as compared to local anesthetic alone. TPVB both with and without the addition of betamethasone resulted in better perioperative analgesia and improved functional status when compared to surgical site local anesthetic infiltration.
Highlights
Laparoscopic cholecystectomy (LC) is a common and high-volume surgical procedure worldwide
The aim of this study was to evaluate the utility of unilateral single injection thoracic paravertebral block (TPVB) with and without the addition of betamethasone for the acute pain management of patient’s undergoing laparoscopic cholecystectomy (LC)
The addition of betamethasone to ropivacaine in TPVB resulted in similar onset but significantly slower block regression between 4 h and 72 h as compared to ropivacaine alone (P < 0.001)
Summary
Laparoscopic cholecystectomy (LC) is a common and high-volume surgical procedure worldwide. While considered a relatively less invasive alternative compared to open cholecystectomy, LC constitutes a profound insult to patients with the duration of pain and post-operative functional recovery ranging from one to seven days. Thoracic paravertebral blocks (TPVB) have proven to be as effective as the more invasive epidural anesthesia in treating somatic/visceral pain and promoting positive recovery metrics in abdominal procedures [2]. In this randomized, double-blind, controlled study of LC patients, we investigated the effects of unilateral TPVB with or without adjuvants, combination of non-particulate and particulate betamethasone, versus surgeon infiltration at port sites, on blockade duration, pain control and other patient-centered perioperative outcomes. The regression of sensory block, an important factor for analgesia duration, was
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