Intermittent Bolus Paravertebral Block Opioid-Sparing analgesic effect among patients undergoing hepatectomy

A recent study published in the BMC Surgery found potential benefits of intermittent bolus paravertebral block on analgesia and recovery in patients undergoing open hepatectomy. The study, conducted on 80 patients aged between 18 and 70 years, has shed light on the advantages of utilizing paravertebral ropivacaine in the management of postoperative pain.

Hepatectomy, a surgical procedure involving the partial removal of the liver, often requires substantial postoperative pain management. To address this, researchers carried out a randomized trial, enrolling patients with American Society of Anesthesiologists (ASA) level I-III, who were scheduled for hepatectomy with a J-shaped subcostal incision. The participants were divided into two groups: one receiving intermittent bolus paravertebral ropivacaine (with 0.5% loading and 0.2% infusion) and the other receiving a 0.9% saline infusion. A total of 38 patients were included in each group, and their outcomes were closely monitored.

The primary outcome measured in the study was the cumulative intravenous morphine consumption through a patient-controlled analgesic pump during the first 48 hours after the operation. Remarkably, the results demonstrated that patients who received the paravertebral block exhibited significantly lower cumulative morphine consumption at postoperative 24 and 48 hours compared to the control group. The opioid-sparing effect of the paravertebral block offers an alternative approach to pain management, potentially reducing the risks associated with opioid use and promoting faster recovery.

Additionally, the study evaluated pain intensity using numerical rating scales at rest and during activity. The group receiving the paravertebral block reported lower pain scores at various time intervals, including postoperative 4 hours and 12 hours. These findings further reinforce the effectiveness of the paravertebral block in managing postoperative pain.

Furthermore, the benefits of the paravertebral block extended beyond the hospital stay. Three months after the surgery, patients in the paravertebral block group experienced lower rates of hypoesthesia (numbness) compared to the control group. This suggests that the use of paravertebral ropivacaine may contribute to improved long-term outcomes and patient satisfaction following hepatectomy.

Reference:

Wang, J., Cui, X., Zhang, Y., Sang, X., & Shen, L. (2023). The effects of intermittent bolus paravertebral block on analgesia and recovery in open hepatectomy: a randomized, double-blinded, controlled study. In BMC Surgery (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12893-023-02125-0