Continuous Paravertebral Block on Postoperative Pain After Hepatectomy
Condition: Right Lobe Hepatectomy
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 2

Summary: 
      Patients often experience moderate to severe postoperative pain, especially during the first
      hours after hepatectomy. Systemic opioids given with patient-controlled analgesia has be used
      after hepatectomy in many medical center(Aubrun, Monsel et al. 2001; Aubrun, Salvi et al.
      2005), but the analgesic effect can be limited and undesirable side effects may occur.

      A case report described that right thoracic paravertebral block reduced pain and analgesic
      requirements after right lobe hepatectomy(Ho, Karmakar et al. 2004). Compared with epidural
      analgesia, thoracic paravertebral block probably carries a much lower risk of spinal
      haematoma in the presence of moderate haemostatic deficiencies (Richardson and Lonnqvist
      1998; Karmakar 2001).

      We therefore designed a prospective, randomized, subject and assessor blinded,
      parallel-group, placebo controlled study to test the hypothesis that continuous right
      thoracic paravertebral analgesia decreases opioid consumption during the first 24 h after
      right lobe hepatectomy in patients receiving i.v. patient-controlled analgesia (PCA) with
      sufentanil.
    


Intervention name(s): Continuous Paravertebral block with ropivacaine; Patient-controlled analgesia with sufentanil; Continuous Paravertebral Block with Saline
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Before anesthesia, continuous right thoracic paravertebral block of T7 is performed. After injection of 5 mL normal saline, a catheter (PAJUNK, Geisingen, Germany) is advanced medially the estimated distance to the paravertebral space. After injection of 1% lidocaine 15ml, the block level is tested by pinprick and recorded 15 minutes later. At the end of operation, syringe contained 0.2% ropivacaine is connected to paravertebral catheter, a 10ml bolus of 0.2% ropivacaine is injected via the paravertebral catheter, followed by an infusion of ropivacaine 0.2% at 6 ml/h for postoperative pain management.; Once arrival at the PACU, all patients were placed on a postoperative analgesic regimen that included patient-controlled analgesia with intravenous sufentanil (bolus 1μg, lockout time 10 min) and tramadol 100 mg IV for severe pain (NRS 6-10).; Before anesthesia, continuous right thoracic paravertebral block of T7 is performed. After injection of 5 mL normal saline, a catheter (PAJUNK, Geisingen, Germany) is advanced medially the estimated distance to the paravertebral space. After injection of 1% lidocaine 15ml, the block level is tested by pinprick and recorded 15 minutes later. At the end of operation, syringe contained 0.9% saline is connected to paravertebral catheter, a 10ml bolus of 0.9% saline is injected via the paravertebral catheter, followed by an infusion of 0.9% saline at 6 ml/h for postoperative pain management.
Intervention MeSH terms: Sufentanil; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Thoracic paravertebral block; Postoperative pain; Right lobe hepatectomy; Patient controlled analgesia