COMPARISON OF UNILATERAL PARAVERTEBRAL BLOCK WITH SUBARACHNOID BLOCK FOR POSTOPERATIVE ANALGESIA IN UNILATERAL INGUINAL HERNIA SURGERIES

Abstract

Girish Sharma1, Dara Singh Negi2, Guntas Sra3

BACKGROUND
Paravertebral Block (PVB) is emerging as an alternative anaesthesia technique for inguinal hernia repair with some advantages over Subarachnoid Block (SAB). This study compares unilateral paravertebral block with subarachnoid block for postoperative analgesia in unilateral inguinal hernia surgeries.
The aim of the study is to study the comparison of Paravertebral Block (PVB) with Subarachnoid Block (SAB) for postoperative pain at 0, 1, 2, 4, 6, 12 and 24 hours and analgesic requirement in first 24 hours in unilateral inguinal hernia surgeries. The onset and extent of sensory and motor block, time to ambulation and patient and surgeon comfort level were also assessed.
MATERIALS AND METHODS
Sixty adult male patients, aged 18-65 years with American Society of Anaesthesiologist (ASA) grade I and II presenting for unilateral inguinal hernia repair over a period of one year were allocated into two groups to receive SAB (Group I, 2.5 cc of 0.5% bupivacaine with clonidine 30 μg at L3-4 level) or PVB (Group II, 30 mL of 0.25% bupivacaine and clonidine 30 μg given at T10, T12 and L2 level). The primary objective was to assess postoperative pain scores on Visual Analogue Scale (VAS) of 0-10 at 0, 1, 2, 4, 6, 12 and 24 hours and analgesic requirement in first 24 hours after surgery. Secondary objectives were to compare onset and depth of sensory and motor block, intraoperative haemodynamic, patient and surgeon comfort level and time for ambulation were also recorded.
RESULTS
Onset of sensory block was faster in Group I (4.5 ± 0.5 vs. 13.1 ± 0.6 mins. in Group II) (P value ?0.001). PVB had advantage of limited extent of sensory and motor block (T8 to L3 as compared to T6 to S5 in Group I). Postoperative Visual Analogue Scale (VAS) was lower in Group II at 4, 6 and 12 hours (P value ?0.001). The mean consumption of diclofenac sodium in first 24 hours in Group I was 72.5 mg while in Group II was 7.5 mg (P value ?0.001). Patient (76.6% vs. 56.6%) and surgeon (86.6% vs. 43.3%) satisfaction was better in Group II.
CONCLUSION
Paravertebral block is better than SAB for unilateral hernia repair in terms of less postoperative pain scores and analgesic requirements in first 24 hours along with less intraoperative haemodynamic variation, no motor blockade and better patient and surgeon satisfaction.

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