Background and aims Post-operative pain in laparoscopic cholecystectomy is variable, multifactorial and unpredictable.1 2 The use of ultrasound-guided paravertebral nerve blocks (PVB) has been explored as part of its multi-modal pain management.1 3 4 This prospective case series explored the use of pre-operative, bilateral, single level paravertebral nerve block in 6 patients.
Methods Six patients for elective laparoscopic cholecystectomy were sedated pre-operatively with Midazolam 1.5 mg IV and Fentanyl 50mcg IV. They were placed in the lateral decubitus position. Linear transducer was placed over T5-T6 level in a median parasagittal axis. A 21G 4-inch Stimuplex needle was inserted in-plane, bilaterally, in a caudad-to-cephalad trajectory, and advanced to reach the PVB space.7 8 9 Test dose of 3 mL Lidocaine 1% + Epinephrine 1:200,000 (maximum 3 mL) was done.6
Group 1 received 0.25% Levobupivacaine, while Group 2 received 0.5% Levobupivacaine at 0.3 ml/kg.7,8,10 Intraoperative hemodynamic parameters, post-operative pain scores, and consumption of opioids were measured.
Results Hemodynamic parameters during incision were unchanged for both groups. During insufflation, MAP and HR were elevated in Group 2 and in one patient in Group 1 (table 2).
Group 2 requested rescue opioid medications at an average of 1.6 hrs sooner, had higher NRS scores, and a higher cumulative opioid requirement than Group 1. There were no complications and adverse events incurred in both groups (table 3).
Conclusions Pre-operative, bilateral, single level paravertebral block provides for stable hemodynamic control during incision in laparoscopic cholecystectomy. The volume of local anesthetic used is sufficient to cover pain up to the fifth hour post-operatively.