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Continuous Right Thoracic Paravertebral Block Following Bolus Initiation Reduced Postoperative Pain After Right-Lobe Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial
  1. Hexiang Chen, MMSc*,,
  2. Zhipin Liao, MMSc*,
  3. Yan Fang, MD*,
  4. Ben Niu, MD*,
  5. Amber Chen,
  6. Fei Cao, MD, PhD*,,
  7. Wei Mei, MD, PhD* and
  8. Yuke Tian, MD, PhD*
  1. *Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
  2. Department of Anesthesiology, Wuhan First Hospital, Wuhan, China
  3. Department of Neuroscience, Baylor College of Medicine, Houston, TX
  1. Address correspondence to: Wei Mei, MD, PhD, Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, China 430030 (e-mail: wmei{at}tjh.tjmu.edu.cn).

Abstract

Background and Objectives We hypothesized that continuous right thoracic paravertebral block, following bolus initiation, decreases opioid consumption after right-lobe hepatectomy in patients receiving patient-controlled intravenous analgesia with sufentanil.

Methods Patients undergoing right-lobe hepatectomy with a right thoracic paravertebral catheter placed at T7 30 minutes before surgery were randomly assigned to receive through this catheter either a 10-mL bolus of 0.2% ropivacaine before emergence, followed by a continuous infusion of 6 mL/h for 24 hours (PVB group), or saline at the same scheme of administration (control group). All patients were started on patient-controlled intravenous analgesia with sufentanil in the postanesthesia care unit. The primary outcome measure was total sufentanil consumption during the first 24 postoperative hours. P = 0.05 was considered as significant. For the multiple comparisons of data at 5 different time points, the P value for the 0.05 level of significance was adjusted to 0.01.

Results Sixty-six patients were assessed for eligibility, and a PVB catheter was successfully placed for 48 patients. Data were analyzed on 22 patients in group PVB and 22 patients in the control group. The cumulative sufentanil consumption in the PVB group (54.3 ± 12.1 μg) at 24 postoperative hours was more than 20% less than that of the control group (68.1 ± 9.9 μg) (P < 0.001). There was also a significant difference in pain scores (numerical rating scale) between groups, where the PVB group had lower scores than did the control group at rest and with coughing for the first 24 hours (P < 0.001).

Conclusions Continuous right thoracic paravertebral block, following bolus initiation, has an opioid-sparing effect on sufentanil patient-controlled intravenous analgesia for right-lobe hepatectomy patients and reduces numerical rating scale pain scores at rest and with coughing in the first 24 postoperative hours.

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Footnotes

  • This work was funded in part by grants from National Natural Science Foundation of People’s Republic of China (no. 31000417 to W.M.) and National Clinical Key Disciplines Construction grant (to Y.T.) from the Ministry of Health of the People’s Republic of China.

    The authors declare no conflict of interest.

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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