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General anaesthesia combined with bilateral paravertebral blockade (T5–6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial

Published online by Cambridge University Press:  23 December 2004

M. Z. Naja ,
M. F. Ziade  and
P. A. Lönnqvist
M. Z. Naja
Affiliation:
Makassed General Hospital, Department of Anaesthesia and Pain Medicine, Beirut, Lebanon
M. F. Ziade
Affiliation:
Lebanese University, Faculty of Public Health, Beirut, Lebanon
P. A. Lönnqvist
Affiliation:
KS/Astrid Lindgrens Children's Hospital, Department of Anaesthesia and Intensive Care, Stockholm, Sweden
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Abstract

Summary

Background and objective: The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative pain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design.

Methods: Patients were randomly assigned to either group. Nerve-stimulator guided paravertebral blockade at the T5–6 level was performed with a local anaesthetic mixture (0.30 mL kg−1). Twenty millilitres of the mixture contained lidocaine 2% 6 mL; lidocaine 2% 6 mL with epinephrine 1/200 000; bupivacaine 0.5% 5 mL; fentanyl 1 mL (50 μg mL−1) and clonidine 2 mL (150 μg mL−1). Postoperative pain and consumption of opioids were assessed during the first 72 h.

Results: Two-times 30 patients were analysed. Patient characteristics data, and pre- and peroperative variables were similar in both groups. Mean pain scores visual analogue scale were significantly less with active compared with control (P < 0.05) at 6 h (1.56 ± 1.58 vs. 4.78 ± 1.67), at 12 h (1.52 ± 1.58 vs. 3.81 ± 1.63), at 24 h (1.16 ± 1.34 vs. 2.71 ± 1.50), at 36 h (0.68 ± 1.02 vs. 2.29 ± 1.41), at 48 h (0.60 ± 1.04 vs. 1.61 ± 1.33) and at 72 h (0.40 ± 0.86 vs. 1.19 ± 1.16). The number of patients consuming supplemental analgesics was significantly less (P < 0.05) with active compared with control, at 6 h (6 vs. 29), at 12 h (2 vs. 26), at 24 h (1 vs. 23) and at 36 h (2 vs. 15). More patients were free from nausea (P < 0.05) with active compared with control at 6 h (23 vs. 9) and at 12 h (29 vs. 19).

Conclusion: When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief.

Keywords

ANAESTHESIA CONDUCTION, paravertebral nerve blockCHOLECYSTECTOMY, LAPAROSCOPICINSTRUMENTATION, nerve stimulatorPOSTOPERATIVE COMPLICATIONS, pain, postoperative
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 489 - 495
Copyright
2004 European Society of Anaesthesiology

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