Summary
pain is a stressor that can threaten homeostasis (a steady physiological state). The adaptive response to such a stress involves physiology changes that, in the initial stages, are useful and are also potentially life-saving.
Unrelieved postoperative pain may result in clinical and psychological changes that increase morbidity, mortality, costs as well as decrease quality of life and potentially increase the incidence of chronic pain. Negative clinical outcomes resulting from ineffective postoperative pain management include deep vein thrombosis and pulmonary embolism, coronary ischemia and myocardial infarction, pneumonia, poor wound healing, insomnia and demoralization. Associated with these complications are economic and humanistic implications such as extended lengths of stay, readmissions, and patient dissatisfaction with medical care. A recent study suggests that pain in ambulatory surgical patients is still undermanaged and the incidence of moderate to severe pain remains high.
Aim of the study: This study was done to evaluate efficacy of both continuous lumbar epidural and ultrasound guided continuous paravertebral block on perioperative analgesia and hemodynamic stability in patients undergoing lower abdominal surgery.
Patients and methods: this prospective randomized blinded clinical study was done on 38 patients above 18 years who were randomized into two equal groups:
group PVB:(19 patients received in-plane ultrasound guided continous lumbar paravertebral block with 15-20 ml(0.3ml/kg) of 0.5% bupivacaine bolus dose followed by continuous infusion of bupivacaine 0.125% with fentanyl 1mcg/ml.
group EPB:(19 patients received continuous lumbar epidural analgesia with 5-8 ml(0.1ml/kg) of 0.5% bupivacaine bolus dose followed by continuous infusion of bupivacaine 0.125% with fentanyl 1mcg/ml.
After insertion of epidural/paravertebral catheters patients were turned supine. General anesthesia was induced with IV fentanyl 1–2 mcg/kg, propofol 2–3 mg/kg followed by rocuronium 0.5–0.8 mg/kg . Anesthesia was maintained with Isoflurane 1.5% and rocuronium 0.15mg/kg as a maintainance dose every 30 minutes till the end of the procedure. Ventilation parameters was adjusted as follows: TV = 7 ml/kg, respiratory rate = 12/min. and peak inspiratory pressure 30- 35 cm H2O. End tidal CO2 will be maintained between 35-40 mmHg.heart rate and MAP were monitored.
The primary outcome measure: is the mean morphine consumption in the first 24 hours postoperative and visual analogue scale ( VAS).
The secondry measures include: age, weight, height, BMI, ASA, vital signs (MAP, HR, RR), type and duration of surgery and complications (nausea, vomiting, pruritis, drowsiness and urine retention).
Results: there was insignificant differences between epidural and paravertebral groups as regarding VAS and total morphine consumption in the first post-operative 24 hours.
As regarding MAP and HR, they were lower in epidural group. complications including nausea, vomiting and urine retention were higher in epidural group.
Conclusion: both continous epidural and continous paravertebral blocks are effective in controlling postoperative pain after lower abdominal surgeries with lower rate of complications (hypotension, bradycardia, nausea, vomiting and urine retention) in paravertebral group.
|
