Unilateral paravertebral block guided by nerve stimulator with a single-level injection for ipsilateral hernioplasty using 0.5% levobupivacaine Hcl versus 2% hyperbaric prilocaine Hcl

Abstract

Background Thoraco-lumbar paravertebral blockade (PVB) provides the best alternative for anesthesia in lower abdominal surgeries owing to minimization of postoperative pain, reduction of nausea and vomiting, shortened hospital stay, patient satisfaction, and rapid return to normal activities. Aim This study was designed to compare two local anesthetics drugs, levobupivacaine Hcl 0.5% versus hyperbaric prilocaine Hcl 2%, used in PVB-guided nerve stimulator. Patients and methods A total of 60 American Society of Anesthesiologists I and II patients scheduled for elective unilateral open technique hernioplasty under regional anesthesia using ipsilateral thoraco-lumber PVB technique were divided into two groups. Patients were randomly assigned to receive a single injection of thoraco-lumbar PVB-guided nerve stimulator with local anesthetic 20 ml in total volume, levobupivacaine Hcl 0.5% (group L) (n=30) and hyperbaric prilocaine Hcl 2% (group HP) (n=30), at 12 thoracic vertebra (T12), with a catheter inserted in PV space. Parameters measured were onset and offset time of anesthesia and motor block, hemodynamics evaluation, numeric rating scale for pain assessment, blood glucose level, cortisol level, interleukin 6 level, time of first voiding, patient satisfaction, postoperative complications, and first 24-h postoperative morphine consumption. Results There was statistically significant longer time of onset of sensory block and motor regression in group L than group HP. Patient stress response was highly significantly lower in each group when compared between values at T0 and T1, whereas the response was significantly lower in HP group only at T1 but insignificantly at T2. Postoperative morphine consumption was significantly higher in group L than group HP only at T0, whereas was insignificant in T1, T2, T3, T4, T5, and T6 postoperatively. Conclusion PVB is a highly efficient anesthetic technique with lesser complications than general or regional anesthesia.