게시판
| 21KS-018 |
Preemptive Analgesic Effect of Thoracic Paravertebral Blocks for Visceral Pain in Laparoscopic Cholecystectomy
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
ABSTRACT
Background and objective: The preemptive analgesic effect of thoracic paravertebral block (TPVB) remains controversial, particularly for visceral postoperative pain. This study sought to compare the analgesic effect of pre- or post-surgical TPVB on postoperative visceral pain in patients undergoing laparoscopic cholecystectomy (LC) who have had pre-incisional rectus sheath block (RSB) to minimize somatic pain.
Methods: Pre-incisional RSB was performed for all participants who underwent elective LC. Patients were randomly assigned to either the pre-TPVB (before incision) or post-TPVB (post-surgery) group. The primary outcome was the total rescue morphine consumption during the 24 hours post-surgery. The secondary outcomes were the cumulative rescue morphine consumption and postoperative pain scores at 0, 0.5, 1, 2, 6, 9, 18, and 24 hours post-surgery.
Results: The mean total rescue morphine consumption during the 24 hours post-surgery was 16.9 g in the pre- and post-TPVB groups, respectively (P = 0.002). The mean difference in total rescue morphine consumption during the 24 hours post-surgery was -8.31 mg (95% CI, -13.4 to -3.2, P = 0.002) The cumulative rescue morphine consumption at 1, 2, 6, 9, 18, and 24 hours post-surgery was significantly lower in the pre-TPVB group than in the post-TPVB group. The pain intensity was significantly lower in the pre-TPVB group than in the post-TPVB group at 0.5, 1, 2, and 6 hours post-surgery.
Conclusion: TPVB with RSB before skin incision reduced total rescue analgesic consumption and provided better pain control in the 24 hours after LC.
1. Woolf CJ, Chong MS. Preemptive analgesiang postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77(2):362-79. doi: 10.1213/00000539-199377020-00026 [published Online First: 1993/08/01]
2. Kissin I. Preemptive analgesia. Anesthesiology 2000;93(4):1138-43. doi: 10.1097/00000542-200010000-00040 [published Online First: 2000/10/06]
Background and objective: The preemptive analgesic effect of thoracic paravertebral block (TPVB) remains controversial, particularly for visceral postoperative pain. This study sought to compare the analgesic effect of pre- or post-surgical TPVB on postoperative visceral pain in patients undergoing laparoscopic cholecystectomy (LC) who have had pre-incisional rectus sheath block (RSB) to minimize somatic pain.
Methods: Pre-incisional RSB was performed for all participants who underwent elective LC. Patients were randomly assigned to either the pre-TPVB (before incision) or post-TPVB (post-surgery) group. The primary outcome was the total rescue morphine consumption during the 24 hours post-surgery. The secondary outcomes were the cumulative rescue morphine consumption and postoperative pain scores at 0, 0.5, 1, 2, 6, 9, 18, and 24 hours post-surgery.
Results: The mean total rescue morphine consumption during the 24 hours post-surgery was 16.9 g in the pre- and post-TPVB groups, respectively (P = 0.002). The mean difference in total rescue morphine consumption during the 24 hours post-surgery was -8.31 mg (95% CI, -13.4 to -3.2, P = 0.002) The cumulative rescue morphine consumption at 1, 2, 6, 9, 18, and 24 hours post-surgery was significantly lower in the pre-TPVB group than in the post-TPVB group. The pain intensity was significantly lower in the pre-TPVB group than in the post-TPVB group at 0.5, 1, 2, and 6 hours post-surgery.
Conclusion: TPVB with RSB before skin incision reduced total rescue analgesic consumption and provided better pain control in the 24 hours after LC.
1. Woolf CJ, Chong MS. Preemptive analgesiang postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77(2):362-79. doi: 10.1213/00000539-199377020-00026 [published Online First: 1993/08/01]
2. Kissin I. Preemptive analgesia. Anesthesiology 2000;93(4):1138-43. doi: 10.1097/00000542-200010000-00040 [published Online First: 2000/10/06]