Comparison of Spinal Anaesthesia and Paravertebral Block in Unilateral Inguinal Hernia Repair

Işıl, Canan Tülay; Çınar, Ayşe Surhan; Oba, Sibel; Işıl, Rıza Gürhan

doi:10.5152/tjar.2014.75508

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…The fall in hemodynamic responses was substantially lesser in the PVB group when compared to the SAB group, and our findings were consistent with previous studies. [ 6 15 16 ] This might have also resulted in the administration of mephentermine in the SAB group to maintain BP during hypotensive state, also consistent with the previous studies. [ 17 ] Although the sympathetic chain is a part of the paravertebral space, not much hemodynamic variation is noticed in PVB since it is a unilateral anesthetic technique.…”

Section: Discussionsupporting

confidence: 78%

“…Although not significantly different, SAB group experienced more adverse effects than in the PVB group, similar to the previous findings. [ 15 ] Urinary retention and vomiting were the two complications observed in the SAB group. The blockade of parasympathetic fibers that innervate the autonomic bladder control might be probable reasons behind the adverse effects in the SAB group.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of paravertebral block with conventional spinal anesthesia in patients undergoing unilateral inguinal hernia repair

Rani

Vaishnavi

et al. 2020

Anesth Essays Res

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Context: Although spinal anesthesia (also known as subarachnoid block [SAB]) is used widely for inguinal hernia repair, the paravertebral block (PVB) that produces unilateral, segmental analgesia is used with a high success rate in inguinal hernia repair. Aims: The aim of the study was to compare SAB and PVB in inguinal hernia repair, in terms of the duration of postoperative analgesia and adverse events. Settings and Design: This was a prospective, randomized, controlled double-blind study. Methods: This study was done on 60 male patients of American Society of Anesthesiology (ASA) I and II. Patients were categorized into 30 in each group, either to receive PVB block at two levels T10 and L1 using 15 mL and 5 mL of 0.5% bupivacaine and 1 μg.kg −1 of buprenorphine or SAB with 12.5 mg of 0.5% hyperbaric bupivacaine injected intrathecally. Statistical Analysis Used: SPSS 18.0 and R version 3.2.2 were used for analyzing the data. Categorical measurements were presented in number (%) and analyzed using Chi-square/Fischer's exact test. Continuous measurements were analyzed using Student's t -test. Results: Age, weight, height, and ASA status were comparable in both the groups. In the PVB group, eight patients had failure of block. Hemodynamic responses, time to first analgesia and ambulation, time required to perform the block, Bromage score, satisfaction score, failure rate, and intra- and postoperative drugs used showed a statistically significant difference between the groups ( P < 0.001). Conclusion: PVB is not a sole anesthetic technique due to a higher failure rate and increased intraoperative fentanyl requirement but has advantages such as prolonged analgesia, stable hemodynamics, and early ambulation.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Comparison of paravertebral block with conventional spinal anesthesia in patients undergoing unilateral inguinal hernia repair

Rani

Vaishnavi

et al. 2020

Anesth Essays Res

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“…It is known to have slow onset and takes longer to reach a peak effect. [ 27 ] Studies have reported time to surgical anesthesia more than 20 min with the use of PVB. [ 28 ] For breast surgery, these values can be significant, so till the peak effect of the block is attained; patient may have already required opioid supplementation.…”

Section: Discussionmentioning

confidence: 99%

Opioid-sparing effects of the thoracic interfascial plane blocks: A meta-analysis of randomized controlled trials

et al. 2018

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Background:Thoracic interfascial plane blocks and modification (PECS) have recently gained popularity for analgesic potential during breast surgery. We evaluate/consolidate the evidence on opioid-sparing effect of PECS blocks in comparison with conventional intravenous analgesia (IVA) and paravertebral block (PVB).Materials and Methods:Prospective, randomized controlled trials comparing PECS block to conventional IVA or PVB in patients undergoing breast surgery published till June 2017 were searched in the medical database. Comparisons were made for 24-h postoperative morphine consumption and intraoperative fentanyl-equivalent consumption.Results:Final analysis included nine trials (PECS vs. IVA 4 trials and PECS vs. PVB 5 trials). PECS block showed a decreased intraoperative fentanyl consumption over IVA by 49.20 mcg (95% confidence interval [CI] =42.67–55.74) (I2 = 98.47%, P < 0.001) and PVB by 15.88 mcg (95% CI = 12.95–18.81) (I2 = 95.51%, P < 0.001). Postoperative, 24-h morphine consumption with PECS block was lower than IVA by 7.66 mg (95% CI being 6.23–9.10) (I2 = 63.15, P < 0.001) but was higher than PVB group by 1.26 mg (95% CI being 0.91–1.62) (I2 = 99.53%, P < 0.001). Two cases of pneumothorax were reported with PVB, and no complication was reported in any other group.Conclusions:Use of PECS block and its modifications with general anesthesia for breast surgery has significant opioid-sparing effect intraoperatively and during the first 24 h after surgery. It also has higher intraoperative opioid-sparing effect when compared to PVB. During the 1st postoperative day, PVB has slightly more morphine sparing potential that may however be associated with higher complication rates. The present PECS block techniques show marked interstudy variations and need standardization.

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“…[ 19 ] In our study, none of the patients of Group PVB experienced motor blockade as reported in the previous studies. [ 20 21 ] Therefore, ambulation occurred much earlier in Group PVB than Group SA, in which bilateral motor blockade precludes ambulation until its anesthetic effects completely wear off.…”

Section: Discussionmentioning

confidence: 99%

“…The results of our study were consistent with those of other studies. [ 4 19 20 ] The time to perform the block was significantly higher in Group PVB (15.79 ± 1.11 min) than Group SA (6.00 ± 0.74 min) because of multiple injections and nerve stimulator-guided technique in Group PVB. The time to surgical anesthesia was significantly higher in Group PVB than Group SA (16.55 ± 2.35 min vs. 8.4 ± 1.43 min) similar to other studies[ 19 ] owing to injections given at multiple levels.…”

Section: Discussionmentioning

confidence: 99%

Comparison of spinal anesthesia and paravertebral block in inguinal hernia repair

et al. 2017

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Context:Inguinal hernia repair (IHR) is a common surgical procedure which can be performed under general, regional, or peripheral nerve block anesthesia.Aim:The aim of our study was to compare the efficacy of paravertebral block (PVB) with spinal anesthesia (SA) for IHR with respect to postoperative analgesia, ambulation, and adverse effects.Settings and Design:This was a prospective, single-blind randomized controlled trial.Materials and Methods:Sixty American Society of Anesthesiologists Class I–II patients of 20–60 years scheduled for IHR were randomized by a computer-generated list into two groups of thirty each, to receive either PVB (Group PVB: at T12–L2 levels, 10 ml of 0.5% levobupivacaine at each level) or SA (Group SA: at L3–L4/L2–L3 level, 2.5 ml of 0.5% levobupivacaine). Primary outcome was duration of postoperative analgesia and time to reach discharge criteria. Secondary outcome was time to ambulation, time to perform the block, time to surgical anesthesia, total rescue analgesic consumption, adverse effects, hemodynamic changes, patient, and surgeon satisfaction.Statistical Analysis Used:Student's t-test, Chi-square test as applicable, and Statistical Package for Social Sciences (version 14.0, SPSS Inc., Chicago, IL, USA) were used.Results:Time to the first analgesic requirement was 15.17 ± 3.35 h in Group PVB and 4.67 ± 1.03 h in Group SA (P < 0.001). Time to reach the discharge criteria was significantly shorter in Group PVB than Group SA (P < 0.001).Conclusion:PVB is advantageous in terms of prolonged postoperative analgesia and encourages early ambulation compared to SA.

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Comparison of Spinal Anaesthesia and Paravertebral Block in Unilateral Inguinal Hernia Repair

Abstract: In conclusion, paravertebral block provides acceptable surgical anaesthesia, maintaining good quality and long duration on postoperative analgesia in unilateral hernia repair.

Cited by 6 publications

References 15 publications

Comparison of paravertebral block with conventional spinal anesthesia in patients undergoing unilateral inguinal hernia repair

Comparison of paravertebral block with conventional spinal anesthesia in patients undergoing unilateral inguinal hernia repair

Opioid-sparing effects of the thoracic interfascial plane blocks: A meta-analysis of randomized controlled trials

Comparison of spinal anesthesia and paravertebral block in inguinal hernia repair

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