Comparative analysis of the paravertebral block and epidural anesthesia in the complex of anesthetic support for laparoscopic kidney surgery: open randomized clinical study

Abstract

BACKGROUND: Laparoscopic kidney surgery is performed mostly under general anesthesia. Regional techniques, primarily epidural anesthesia / analgesia (EA), help improve the surgical results. However, EA is often accompanied by several complications and side effects. The thoracic paravertebral block (PVB) is considered a reasonable and effective alternative.

OBJECTIVE: To conduct a comparative analysis of the effectiveness of general anesthesia (GA) + PVB, GA alone, and GA + EA in laparoscopic kidney surgery.

MATERIALS AND METHODS: An open-label randomized clinical study enrolled 180 patients who underwent laparoscopic kidney surgery. By using an online tool (https//www resource.studyrandomizer.com), the patients were divided into three groups in a 1:1:1 ratio. Group 1 (n=60) underwent surgery under GA + PVB, group 2 (n=60) under GA, and group 3 under GA + EA. In each group, the intra-, and postoperative need for opioids, pain intensity on a visual analog scale (VAS) 1, 6, 12, and 24 h after surgery, and activation time were assessed. The results of the groups were compared. The frequency and nature of complications when performing and working with PVB were studied.

RESULTS: The intraoperative need for opioids was greater in the GA group and comparable in the GA + PVB and GA + EA groups (p=0.137). The postoperative pain in the PVB group remained consistently low (VAS score ≈2 points) during the observation period. In the GA group, it reached ≈5 points after 1, 6, and 12 h and ≈4 points 24 h after the surgery; in the EA group, it was ≈4 points (1, 6, and 12 h) and ≈3 points 24 h after the surgery. The prolonged PVB in the postoperative period significantly lowered the opioid need (p=0.045) and contributed to earlier activation of the patients (p=0.001). Under ultrasound control, PVB is safe, and effective.

CONCLUSION: The study showed that PVB in the complex of anesthetic support for kidney surgery provides an effective and safe anesthesia / analgesia and can be used as an alternative to EA.

Keywords

laparoscopic kidney surgery / ultrasound navigation / paravertebral block / pain / visual analog scale

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RIGHTS & PERMISSIONS

Lapkina I.V., Ovechkin A.M., Alekseeva T.M., Kozlov V.V., Bezrukov E.A., Slusarenko R.I.