You are here

Article Text

Article menu
Download PDFPDF
ORIGINAL ARTICLES
Paravertebral Block in Inguinal Hernia Surgeries: Two Segments or 4 Segments?
  1. Derya Özkan, MD*,
  2. Taylan Akkaya, MD*,
  3. Ayhan Cömert, MD†,
  4. Nilgün Balıkcı, MD*,
  5. Esra Özdemir, MD*,
  6. Haluk Gümüs, MD*,
  7. Zafer Ergül, MD‡ and
  8. Oskay Kaya, MD‡
  1. From the *Department of Anesthesiology and Reanimation Clinic, Ministry of Health Ankara, Diskapi Yildirim Beyazit Education and Research Hospital;
  2. †Department of Anatomy, Ankara University Faculty of Medicine; and
  3. ‡Department of Surgery Clinic, Ministry of Health Ankara, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
  1. Address correspondence to: Derya Özkan, MD, Koru M Kavaklı S Mine Blok 44, Mesa Koru Çayyolu, Ankara, Turkey (e-mail: derya_z{at}yahoo.com).

Abstract

Background and Objectives: In this study, we compare paravertebral block (PVB) of the T10 and L1 segments and multiple-segment PVB for anesthesia and analgesia in inguinal hernia surgeries.

Methods: Anatomic study was performed on 3 cadavers. A 15-mL methylene blue solution was injected at the T10 level and then an additional 5-mL dye injection at L1 level. Fifty patients were included in the study. Patients in group 1 (n = 25) underwent PVB of 2 segments at the T10 and L1 vertebrae levels on the same side as the hernia, whereas patients in group 2 (n = 25) underwent PVB through 4 segments at T10, T11, T12, and L1 on the same side as the hernia. Perioperative propofol/remifentanil consumption, surgery start time, time to perform the block, duration of sensory block, postoperative visual analog scale scores, and complications were evaluated.

Results: Any passage down to the T12 level was not observed after injection at the T10 level and also only after additional 5-mL dye injection at the L1 level; the genitofemoral, ilioinguinal, iliohypogastric, and lateral femoral cutaneous nerves were stained with dye in cadavers. The times for block application were 5 mins (SD, 1 min) in group 1 and 16 mins (SD, 4 mins) in group 2 (P < 0.001). The surgery start time was 25 mins (SD, 3 mins) in group 1 and 27 mins (SD, 6 mins) in group 2 (P = 0.234). In both groups, propofol and remifentanil were used in similar quantities during the perioperative period. Use of paracetamol tablets was similar in both groups (P > 0.05). Whereas none of the patients in group 1 displayed motor block or contralateral spread, 2 patients in group 2 displayed contralateral spread, and motor block was observed in 1 patient. Twenty-three patients (92%) in group 1 and 24 patients (96%) in group 2 were satisfied with the method (P > 0.05).

Conclusion: Two-segment PVB can be an alternative to 4-segment PVB in inguinal hernia surgeries. Decreasing the number of injections required in this technique may further increase patient comfort and decrease complications.

https://doi.org/10.1097/AAP.0b013e3181ae1169

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.