Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-08T17:34:38.169Z Has data issue: false hasContentIssue false
  • English
  • Français

General anaesthesia combined with bilateral paravertebral blockade (T5–6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial

Published online by Cambridge University Press:  23 December 2004

M. Z. Naja ,
M. F. Ziade  and
P. A. Lönnqvist
M. Z. Naja
Affiliation:
Makassed General Hospital, Department of Anaesthesia and Pain Medicine, Beirut, Lebanon
M. F. Ziade
Affiliation:
Lebanese University, Faculty of Public Health, Beirut, Lebanon
P. A. Lönnqvist
Affiliation:
KS/Astrid Lindgrens Children's Hospital, Department of Anaesthesia and Intensive Care, Stockholm, Sweden
Get access

Abstract

Summary

Background and objective: The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative pain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design.

Methods: Patients were randomly assigned to either group. Nerve-stimulator guided paravertebral blockade at the T5–6 level was performed with a local anaesthetic mixture (0.30 mL kg−1). Twenty millilitres of the mixture contained lidocaine 2% 6 mL; lidocaine 2% 6 mL with epinephrine 1/200 000; bupivacaine 0.5% 5 mL; fentanyl 1 mL (50 μg mL−1) and clonidine 2 mL (150 μg mL−1). Postoperative pain and consumption of opioids were assessed during the first 72 h.

Results: Two-times 30 patients were analysed. Patient characteristics data, and pre- and peroperative variables were similar in both groups. Mean pain scores visual analogue scale were significantly less with active compared with control (P < 0.05) at 6 h (1.56 ± 1.58 vs. 4.78 ± 1.67), at 12 h (1.52 ± 1.58 vs. 3.81 ± 1.63), at 24 h (1.16 ± 1.34 vs. 2.71 ± 1.50), at 36 h (0.68 ± 1.02 vs. 2.29 ± 1.41), at 48 h (0.60 ± 1.04 vs. 1.61 ± 1.33) and at 72 h (0.40 ± 0.86 vs. 1.19 ± 1.16). The number of patients consuming supplemental analgesics was significantly less (P < 0.05) with active compared with control, at 6 h (6 vs. 29), at 12 h (2 vs. 26), at 24 h (1 vs. 23) and at 36 h (2 vs. 15). More patients were free from nausea (P < 0.05) with active compared with control at 6 h (23 vs. 9) and at 12 h (29 vs. 19).

Conclusion: When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief.

Keywords

ANAESTHESIA CONDUCTION, paravertebral nerve blockCHOLECYSTECTOMY, LAPAROSCOPICINSTRUMENTATION, nerve stimulatorPOSTOPERATIVE COMPLICATIONS, pain, postoperative
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 489 - 495
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Luman W, Adams WH, Nixon SN, et al. Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut 1996; 39: 863–866.Google Scholar
Frazee RC, Roberts JW, Okeson GC, et al. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Ann Surg 1991; 213: 651–653; discussion 653–654.Google Scholar
Wastell C. Laparoscopic cholecystectomy. BMJ 1991; 302: 303–304.Google Scholar
Grace PA, Quereshi A, Coleman J, et al. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg 1991; 78: 160–162.Google Scholar
Joris J, Cigarini I, Legrand M, et al. Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth 1992; 69: 341–345.Google Scholar
O'Boyle CJ, deBeaux AC, Watson DI, et al. Helium vs carbon dioxide gas insufflation with or without saline lavage during laparoscopy. Surg Endosc 2002; 16: 620–625.Google Scholar
Tsereteli Z, Terry ML, Bowers SP, et al. Prospective randomized clinical trial comparing nitrous oxide and carbon dioxide pneumoperitoneum for laparoscopic surgery. J Am Coll Surg 2002; 195: 173–179.Google Scholar
Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 1995; 81: 379–384.Google Scholar
Bisgaard T, Klarskov B, Kristiansen VB, et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg 1999; 89: 1017–1024.Google Scholar
Dath D, Park AE. Randomized, controlled trial of bupivacaine injection to decrease pain after laparoscopic cholecystectomy. Can J Surg 1999; 42: 284–288.Google Scholar
Rademaker BM, Kalkman CJ, Odoom JA, de Wit L, Ringers J. Intraperitoneal local anaesthetics after laparoscopic cholecystectomy: effects on postoperative pain, metabolic responses and lung function. Br J Anaesth 1994; 72: 263–266.Google Scholar
Scheinin B, Kellokumpu I, Lindgren L, Haglund C, Rosenberg PH. Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1995; 39: 195–198.Google Scholar
Bigler D, Dirkes W, Hansen R, Rosenberg J, Kehlet H. Effects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy. Acta Anaesthesiol Scand 1989; 33: 561–564.Google Scholar
Giesecke K, Hamberger B, Jarnberg PO, Klingstedt C. Paravertebral block during cholecystectomy: effects on circulatory and hormonal responses. Br J Anaesth 1988; 61: 652–656.Google Scholar
Richardson J, Lönnqvist PA. Thoracic paravertebral block. Br J Anaesth 1998; 81: 230–238.Google Scholar
Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia 2001; 56: 1184–1188.Google Scholar
Naja Z, el Hassan MJ, Khatib H, Ziade MF, Lönnqvist PA. Combined sciatic-paravertebral nerve block vs. general anaesthesia for fractured hip of the elderly. Middle East J Anesthesiol 2000; 15: 559–568.Google Scholar
Naja MZ, el Hassan MJ, Oweidat M, Zbibo R, Ziade MF, Lönnqvist PA. Paravertebral blockade vs. general anesthesia or spinal anesthesia for inguinal hernia repair. Middle East J Anesthesiol 2001; 16: 201–210.Google Scholar
Naja Z, Ziade MF, Lönnqvist PA. Bilateral paravertebral somatic nerve block for ventral hernia repair. Eur J Anaesthesiol 2002; 19: 197–202.Google Scholar
Alexander DJ, Ngoi SS, Lee L, et al. Randomized trial of periportal peritoneal bupivacaine for pain relief after laparoscopic cholecystectomy. Br J Surg 1996; 83: 1223–1225.Google Scholar
Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 1996; 10: 44–48.Google Scholar
Mraovic B, Jurisic T, Kogler-Majeric V, Sustic A. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1997; 41: 193–196.Google Scholar
Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg 2000; 87: 273–284.Google Scholar
Tsimoyiannis EC, Siakas P, Tassis A, Lekkas ET, Tzourou H, Kambili M. Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecstectomy. World J Surg 1998; 22: 824–828.Google Scholar
Richardson J, Jones J, Atkinson R. The effect of thoracic paravertebral blockade on intercostal somatosensory evoked potentials. Anesth Analg 1998; 87: 373–376.Google Scholar
Pettersson N, Perbeck L, Brismar B, Hahn RG. Sensory and sympathetic block during interpleural analgesia. Reg Anesth 1997; 22: 313–317.Google Scholar
Conacher ID. Resin injection of thoracic paravertebral spaces. Br J Anaesth 1988; 61: 657–661.Google Scholar
Conacher ID, Kokri M. Postoperative paravertebral block for thoracic surgery. A radiological appraisal. Br J Anaesth 1987; 59: 155–161.Google Scholar
Saito T, Den S, Cheema SP, et al. A single-injection, multi-segmental paravertebral block-extension of somatosensory and sympathetic block in volunteers. Acta Anaesthesiol Scand 2001; 45: 30–33.Google Scholar
Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand 1999; 43: 770–774.Google Scholar
Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of clonidine added to mepivacaine prolongs the duration of anaesthesia and analgesia after axillary brachial plexus block. Anesth Analg 1996; 83: 1046–1050.Google Scholar
Giannoni C, White S, Enneking FK, Morey T. Ropivacaine with or without clonidine improve pediatric tonsillectomy pain. Arch Otolaryngol Head Neck Surg 2001; 127: 1265–1270.Google Scholar
Sanchez R, Nielsen H, Heslet L, Iversen AD. Neuronal blockade with morphine. A hypothesis. Anaesthesia 1984; 39: 788–789.Google Scholar
Mays KS, Lipman JJ, Schnapp M. Local analgesia without anesthesia using peripheral perineural morphine injections. Anesth Analg 1987; 66: 417–420.Google Scholar
Vinson-Bonnet B, Coltat JC, Fingerhut A. Local Infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Dis Colon Rectum 2002; 45: 104–108.Google Scholar
Fazi L, Jantzen EC, Rose JB, Kurth CD, Watcha MF. A comparison of oral clonidine and oral midazolam as preanesthetic medications in the pediatric tonsillectomy patient. Anesth Analg 2001; 92: 56–61.Google Scholar
Tighe SQ. Paravertebral block. Anaesthesia 2002; 57: 511–512.Google Scholar