Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.018
Brazilian Journal of Anesthesiology
Clinical Research

Paravertebral block using levobupivacaine or dexmedetomidine-levobupivacaine for analgesia after cholecystectomy: a randomized double-blind trial

Bloqueio paravertebral usando levobupivacaína ou dexmedetomidina-levobupivacaína para analgesia após colecistectomia: um estudo duplo-cego randomizado

Indu Mohini Sen, K. Prashanth, Nidhi Bhatia, Nitika Goel, Lileswar Kaman

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Abstract

Background
Thoracic paravertebral block (TPVB) has emerged as an effective and feasible mode of providing analgesia in laparoscopic cholecystectomy. Though a variety of local anaesthetic combinations are used for providing TPVB, literature is sparse on use of dexmedetomidine in TPVB. We aimed to compare levobupivacaine and levobupivacaine-dexmedetomidine combination in ultrasound guided TPVB in patients undergoing laparoscopic cholecystectomy.

Methodology
70 ASA I/II patients, aged 18-60 years, scheduled to undergo laparoscopic cholecystectomy under general anaesthesia were enrolled and divided into two groups. Before anaesthesia induction, group A patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml normal saline while group B patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml solution containing dexmedetomidine 1 μg.kg-1. Patients were monitored for pain using Numeric Rating Scale (NRS) at rest, on movement, coughing and comfort scores post surgery. Total analgesic consumption in first 48 hour postoperative period, time to first request analgesic and pain scores were recorded.

Results
Total amount of rescue analgesia (injection tramadol plus injection tramadol intravenous equivalent dose) consumed during 48 hours postoperatively in group A was 146.55 mg while in group B was 111.30 mg (p = 0.026). Mean time for demanding rescue analgesia was 273 minutes in group A while in group B was 340 minutes (p = 0.00).

Conclusion
TPVB using dexmedetomidine 1 μg.kg-1 added to levobupivacaine 0.25% in patients undergoing laparoscopic cholecystectomy significantly reduced total analgesic consumption in first 48 hours and provided longer duration of analgesia postoperatively compared to levobupivacaine 0.25% alone.

Keywords

Laparosopic cholecystectomy;  Thoracic paravertebral block;  Levobupivacaine;  Dexmedetomidine;  Postoperative analgesia

Resumo

Introdução: O bloqueio paravertebral torácico (BPVT) surgiu como um modo eficaz e viável de fornecer analgesia na colecistectomia laparoscópica. Embora uma variedade de combinações de anestésicos locais seja usada para fornecer BPVT, a literatura é escassa sobre o uso de dexmedetomidina em TPVB. Nosso objetivo foi comparar levobupivacaína e combinação de levobupivacaína-dexmedetomidina em BPVT guiado por ultrassom em pacientes submetidos à colecistectomia laparoscópica. Metodologia: 70 pacientes ASA I/II, com idade entre 18 e 60 anos, programados para colecistectomia laparoscópica sob anestesia geral foram incluídos e divididos em dois grupos. Antes da indução da anestesia, os pacientes do grupo A receberam BPVT guiado por ultrassom unilateral direito com 15ml de levobupivacaína a 0,25% mais 2ml de solução salina normal, enquanto os pacientes do grupo B receberam BPVT unilateral direito guiado por ultrassom com 15 ml de levobupivacaína a 0,25% mais 2ml de solução contendo dexmedetomidina 1µg.kg-1. Os pacientes foram monitorados quanto à dor por meio da Escala de Avaliação Numérica (NRS) em repouso, em movimento, tosse e pontuação de conforto pós-cirurgia. O consumo total de analgésico nas primeiras 48 horas de pós-operatório, o tempo para a primeira solicitação de analgésico e os escores de dor foram registrados. Resultados: A quantidade total de analgesia de resgate (injeção de tramadol mais injeção de tramadol em dose equivalente intravenosa) consumida durante 48 horas no pós-operatório no grupo A foi de 146,55mg, enquanto no grupo B foi de 111,30 mg (p = 0,026). O tempo médio para solicitar analgesia de resgate foi de 273 minutos no grupo A, enquanto no grupo B foi de 340 minutos (p = 0,00). Conclusão: O BPVT usando dexmedetomidina 1µg.kg-1 adicionado à levobupivacaína 0,25% em pacientes submetidos à colecistectomia laparoscópica reduziu significativamente o consumo total de analgésico nas primeiras 48 horas e proporcionou maior duração da analgesia no pós-operatório em comparação à levobupivacaína 0,25% sozinha.

Palavras-chave

Colecistectomia laparosópica; Bloqueio paravertebral torácico; Levobupivacaína; Dexmedetomidina; Analgesia pós-operatória

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