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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2009 December;75(12):684-91
Ambulatory inguinal herniorrhaphy: paravertebral block versus spinal anesthesia
Akcaboy E. Y., Akcaboy Z. N., Gogus N. ✉
Ankara Numune Research and Training Hospital, Department of Anesthesiology and Resuscitation, Ankara, Turkey
AIM. Inguinal herniorrhaphy (IH) is a common surgical procedure that can be successfully performed by using general, regional or local anesthesia and is usually performed in an outpatient setting. In this study, recovery profile, incidence of adverse effects, postoperative pain scores and patient satisfaction between paravertebral block (PVB) and spinal anesthesia (SA) for fast track ambulatory IH were compared.
METHODS: Sixty patients were randomly assigned to receive either PVB or unilateral SA under standardized protocols (PVB at T9-L1 levels with 5 mL of 0.5 % levobupivacaine for each, unilateral SA at L2-L3 level with 8 mg 0.5% hyperbaric levobupivacaine). All patients were sedated with propofol, 10-70 mg.kg.min. Data on anesthesia, surgery and PACU times, hemodynamic changes, home readiness, pain, and incidence of adverse effects were recorded.
RESULTS: One block failed in the PVB group. Anesthesia-related time and onset time were longer in the PVB group, but phase 1 PACU time, time to home-readiness with and without voiding and actual discharge time were significantly shorter in the PVB group. Although the fast-tracking rate was higher in the PVB group, this difference was not significant. The mean propofol dose was higher in the PVB group (52.03±19.32 [35-73] mg.kg.min-1) than in the SA group (44.0±18.8 [33-70] mg.kg.min-1) (P=0.002). VAS scores at 4, 6 and 12 hours were significantly lower in the PVB group, both at rest and during movement. VAS scores at 30, 60, 120, 180 min and at 18, 24 and 48 hours were comparable in the two groups. Duration of sensory block, onset time of discomfort, time to first analgesic, and time to first rescue analgesic were longer in the PVB group.
CONCLUSIONS: In ambulatory IH, PVB provided shorter home readiness time, long lasting postoperative analgesia and improved quality of recovery, and could be a good alternative to SA.