BACKGROUND: The study was done to compare analgesic efficacy of ultrasound-guided continuous lumbar paravertebral block, continuous transversus abdominis plane block and continuous lumbar epidural block, on postoperative analgesia in patients undergoing abdominal surgeries (unilateral inguinal hernia repair). We evaluated their analgesic efficacy over the first 24 postoperative, in a randomized, single-blind, clinical trial in 60 Patients divided into three equal groups, 20 patients in each group.
METHODS: Sixty Patients were randomized into three equal groups, 20 patients in each group Group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.5% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.25%(0.1 ml/kg/hr).Group T received ultrasound-guided transversus abdominis plane block with 20 ml of bupivacaine 0.5% followed by continuous infusion of bupivacaine 0. 25%, (0.1 ml/kg/hr ) and Group E received continuous lumbar epidural analgesia with bupivacaine 0.5% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0. 25% (0.1 ml/kg/hr) . General anesthesia was induced with fentanyl 1-2 mcg/kg and propofol 1–3 mg/kg followed by rocuronium 0.6 mg/kg. .Activation of a regional block at the end of the surgical procedure with the recording of parameters in the post-operative period. Each patient was assessed for morphine consumption, visual analogue scale (VAS) at rest and on movement, vital signs and presence of complications (nausea, vomiting, sedation and pruritis) postoperatively by a blinded investigator in the post-anesthesia care unit (PACU) and at one , two, 6, 12 and 24 h postoperatively.
RESULTS: The postoperative analgesia is more effective with group E ( the gold standard ) than group P and group T, the latter is being the least effective in postoperative pain control ( Epidural > Paravertebral > TAP). Also, the postoperative consumption of morphine in group E is lower than in group P and group T. As regard complications during the study in all groups, complications as nausea, vomiting, pruritis and drowsiness were recorded which were more in epidural than paravertebral and TAP block.
CONCLUSION: Continuous lumbar epidural block is more effective in postoperative analgesia when compared to continuous paravertebral and continuous transversus abdominis plane block, but regarding complications in all groups, there was a higher incidence of complications (hypotension, nausea, and vomiting) in patients received epidural analgesia than in other groups
Keywords: Paravertebral, Epidural , TAP block, Ultrasound guided, postoperative analgesia.
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