Paravertebral block versus epidural anesthesia for lower abdominal surgeries

Ashraf A. AbouSlemah, John N. Bestarous
Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
Ashraf A. AbouSlemah
MD, 1 1 42, The Fourth Stage Armed Forces Buildings, The Fifth Flat, The Home No. 51, The Tenth District, Nasr City ZahrauA, Nasr City, Cairo
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.7123/01.ASJA.0000433032.32476.78

Paravertebral block provides effective intraoperative and postoperative analgesia for many thoracic and abdominal surgeries both in children and in adults. This technique has a low failure rate, fewer complications, and can be unilaterally used in unilateral procedures and whenever epidural anesthesia is contraindicated. We aimed to compare the anesthetic effectiveness of a paravertebral block with epidural anesthesia in lower abdominal procedures.

This prospective study included 60 patients who underwent different lower abdominal surgeries, divided into two equal groups: group I [lumbar epidural (LE) group] received LE anesthesia and group II [thoracolumbar paravertebral (TLP) group] received a unilateral TLP block. In both groups, the anesthetic regimen was a single injection of bupivacaine 0.5% (10–14 ml) for intraoperative anesthesia, followed by bupivacaine 0.125% (10–14 ml) every 8 h or according to the patient’s needs for postoperative analgesia. Patients were assessed for hemodynamic parameters (heart rate and mean arterial pressure), motor blockade (Bromage scale), intensity of pain (visual analogue scale), the stress response (perioperative changes in serum glucose and adrenaline levels), and any perioperative complications. Assessment started from the onset of the block and continued for the first 24 h postoperatively.

Visual analogue scale (pain) scores were lower (better) in the TLP group at all times; the differences were statistically significant (P<0.05) at 1, 2, and 8 h after block, whereas they were comparable (P>0.05) at 4, 6, 10, 12, 18, and 24 h. Only one patient (3.33%) in the TLP group and two (6.67%) in the LE group required systemic analgesic supplementation postoperatively (P>0.05). Motor block was predominant in the LE group at 1, 2 (P<0.001), and 4 h (P<0.05) after block. Hemodynamic stability was better in the TLP group. Only one patient had intraoperative hypotension in the TLP group compared with three in the LE group (P>0.05). Serum glucose and adrenaline levels were lower in the TLP group at almost all times, with comparable results (P>0.05). Both techniques were uncomplicated.

Paravertebral blockade provided higher quality intraoperative and postoperative analgesia, and offered better modification of the stress response and a better side effect/complication profile than epidural anesthesia; however, the results were generally comparable.