Comparative evaluation of ropivacaine and levobupivacaine for postoperative analgesia after ultrasound-guided paravertebral block in patients undergoing percutaneous nephrolithotomy

Saroa, Richa; Palta, Sanjeev; Puri, Siddharath; Kaur, Ravinder; Bhalla, Vidur; Goel, Atin

doi:10.4103/joacp.joacp_187_17

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…The patients with PCIA had a lower VAS score than those in the other two groups at the 24-h time point. Nonetheless, the mean VAS scores of the three groups at this time were <2, suggesting that the postoperative pain was generally limited to the first day after surgery; this finding is consistent with previous reports (13,23). There was no significant difference in pain scores among the three groups 48 h after surgery.…”

Section: Discussionsupporting

confidence: 90%

“…Paravertebral block is a simple and effective technique for unilateral procedures, with minimal incidence of hypotension and urinary retention (7,21). There are several reports on the use of paravertebral block for percutaneous nephrolithotomy, though it is mainly used for intraand postoperative analgesia (13,(21)(22)(23). Mei et al presented reports to share their experience with paravertebral block as the main anesthesia used for percutaneous nephrolithotomy (24,25).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study

Fei

Qin²,

An³

et al. 2023

Front. Med.

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BackgroundGeneral anesthesia is used in the majority of patients undergoing percutaneous nephrolithotomy. To reduce the general anesthesia-related risks and complications, this study evaluated the efficacy and safety of the paravertebral block as a novel and alternative anesthetic method for percutaneous nephrolithotomy.MethodsThis was a retrospective study. A total of 198 patients under percutaneous nephrolithotomy were included. Among them, 76 patients received paravertebral block and 122 received general anesthesia. Patients’ characteristics, surgical outcomes, anesthetic outcomes, and perioperative complications and the visual analog scale (VAS) were recorded to evaluate the efficacy and safety of paravertebral block compared with general anesthesia. Intergroup differences of the parameters were analyzed using an independent t-test and χ2-tests appropriate.ResultsSeventy-six patients who underwent paravertebral block completed the surgery successfully, three patients were supplemented with propofol for discomfort during ureteroscopy, and two patients were supplemented with remifentanil for incomplete nerve blockade. Patients who underwent paravertebral block had a higher American Society of Anesthesiologists grade and heart function grade, including patients with contraindications to general anesthesia. Intraoperative and postoperative adverse events and the anesthesia costs were less in patients who underwent paravertebral block. VAS pain scores during the postoperative period in patients who underwent paravertebral block were lower than those in patients who underwent general anesthesia without the use of patient-controlled intravenous analgesia.ConclusionIn this retrospective study, paravertebral block was found to be effective and safe in providing intraoperative anesthesia for percutaneous nephrolithotomy, and had less adverse events and anesthesia costs. Paravertebral block is an attractive alternative anesthesia for patients at increased risk of comorbidities following general or neuraxial anesthesia.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study

Fei

Qin²,

An³

et al. 2023

Front. Med.

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“…In addition, this meta-analysis also showed that PVB prolonged the time to first postoperative analgesia requirement and reduced the incidence of postoperative additional analgesia in renal surgery. Subgroup analysis revealed that the first postoperative analgesia time of PVB using bupivacaine was significantly prolonged, which was similar to the results of Saroa et al ( 34 ), indicating that the use of bupivacaine for PVB was more beneficial for pain management of patients undergoing renal surgery. And the reduction in the incidence of postoperative additional analgesia was more significant in PCNL.…”

Section: Discussionsupporting

confidence: 86%

“…In recent years, clinical studies indicated that PVB can be used for postoperative analgesia in patients undergoing renal surgery ( 33 ). Saroa et al ( 34 ) reported that ipsilateral PVB guided by a single ultrasound, whether levobupivacaine or ropivacaine, can provide adequate and effective analgesia after PCNL. In other renal surgeries, such as nephrectomy, PVB also has excellent postoperative analgesia reported by Tomar et al ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials

Zhao¹,

Kan

Huang³

et al. 2022

Front. Surg.

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BackgroundParavertebral block (PVB) has been widely used in postoperative analgesia, especially in thoracic and breast surgery. However, the efficacy and safety of PVB for analgesia after renal surgery remains uncertain. Therefore, this study aimed to determine the postoperative analgesic efficacy and safety of PVB in renal surgery.MethodsPubMed, Web of Science, Embase, and the Cochrane Library databases were systematically searched up to December 20, 2021. All randomized controlled trials (RCTs) evaluating the postoperative analgesic efficacy of PVB in renal surgery were collected. The meta-analysis was performed using RevMan 5.4 and Stata/MP 14.0 software.ResultsA total of 16 RCTs involving 907 patients were included in the meta-analysis. Ten studies investigated patients under percutaneous nephrolithotomy (PCNL), and six studies were done for patients under other renal surgery (nephrectomy or pyeloplasty). Compared with control groups (no block, sham block, or other nerve blocks), meta-analysis showed that PVB reduced 24-hour postoperative opioid consumption significantly (SMD = −0.99, 95%CI: −1.60–0.38, p = 0.001, I2 = 92%) and reduced pain scores at various time points within 24 h at rest and 1 h, 4 h, and 24 h at movement after renal surgery, furthermore, PVB prolonged the time to first postoperative analgesic requirement (SMD = 2.16, 95%CI: 0.94–3.39, p = 0.005, I2 = 96%) and reduced the incidence of postoperative additional analgesia (OR = 0.14, 95%CI: 0.06∼0.33, p < 0.00001, I2 = 50%). Subgroup analysis revealed that the postoperative analgesia effect of PVB was more significant in PCNL, and the use of bupivacaine for PVB seemed to have a better performance. Besides, there was no difference in the incidence of postoperative nausea, vomiting, and itching between PVB and control groups.ConclusionThis study indicates that PVB may provide effective postoperative analgesia in patients under renal surgery, especially PCNL patients. Moreover, PVB is a safe analgesic method without significant analgesia-related complications.

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“…They concluded that the time to first analgesic requirement was longer in the LB group (1.60 + 3.64 h) than in the RB group (0.33 + 1.04 h), but it was not statistically significant. 20 In the current study, we used ultrasound to guide PVB at T 9 -10 , T 10 -11 , and T 11 -12 levels, using 5ml of 0.25 % Levobupivacaine at each level. In the PVB group, the VAS score and opioid consumption decreased significantly.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ultrasound guided Thoracic Paravertebral block for postoperative analgesia in Patients Undergoing Percutaneous Nephrolithotomy Surgeries

Devaram¹,

Arumulla²,

Midathala

et al. 2023

PMJUA

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Background: percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery to treat renal stones. Post-operative pain is distressing to the patient due to the injury to the capsule. Efficacy of ultrasound-guided thoracic paravertebral block at multiple level (T9–T10, T10–T11, T11–T12) was evaluated to manage postoperative analgesia in percutaneous nephrolithotomy surgeries.Methodology: a prospective randomized double-blind study of 60 cases of the American Society of Anesthesiologists I–II patients who underwent percutaneous nephrolithotomy were allocated into group P (test) and group N (control). Immediately after surgery, group P were given ultrasound-guided paravertebral block at T9–T10, T10–T11, T11–T12 on operated side using 5 ml of 0.25 % Levobupivacine at each level, while group N did not receive paravertebral block. The patients were assessed for visual analogue scale (VAS), time for first rescue analgesic, number of rescue analgesics in first 24 hrs postoperatively.Results: VAS pain scale shows significant difference between group P (4.2 + 0.8) and group N (5.3 + 1.1) (p < 0.05) at 30 mins, 2, 4, 8 hrs postoperatively. Total opioid consumption at postoperative 2, 6, and 24 hrs was less in group P than group N (P < 0.05). Number of rescue analgesics in first 24 hrs post-surgery in group P was 3.0 ± 0.4, and 4.0 ± 1.1 in group N with statistical significant difference (p = 0.0001). Total dose of opioid consumption (mg) in group P was 110 ± 40.45, and 155 ± 64.87 mg in group N with statistical significant difference (p = 0.002). The group N cases used more opioid than group P, with lower scores for satisfaction (p < 0.05). Analgesic consumption in postoperative 24 hrs of group P was less than that of group N (P = 0.001). Patient satisfaction score was significantly higher in group P than group N (P = 0.0001) in 24 hrs. No nausea and/or vomiting were noted in both groups.Conclusion: ultrasound-guided thoracic paravertebral block had more analgesic, and reduce the requirement of opioids and maintains stable hemodynamics.

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Comparative evaluation of ropivacaine and levobupivacaine for postoperative analgesia after ultrasound-guided paravertebral block in patients undergoing percutaneous nephrolithotomy

Cited by 5 publications

References 23 publications

Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study

Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study

The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and meta-analysis of randomized controlled trials

Efficacy of ultrasound guided Thoracic Paravertebral block for postoperative analgesia in Patients Undergoing Percutaneous Nephrolithotomy Surgeries

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