EFFICACY OF COMBINATION OF THORACIC PARAVERTEBRAL BLOCK AND IV PCA TO IV PATIENT CONTROLLED ANALGESIA ALONE FOR POSTOPERATIVE PAIN MANAGEMENT IN NEPHRECTOMY PATIENTS

Résumé du livre

Introduction-Postoperative analgesia following renal surgery is essential to allow effective coughing, early extubation and to reduce the incidence of postoperative respiratory complications.Aims and objectives-Aims and objectives of this study were to compare thoracic paravertebral block(TPVB) and IV PVC (iv fentanyl) with IV PCA alone for postoperative analgesia in patients undergoing open nephrectomy and too compare intraoperative and postoperative hemodynamic changes and incidence of side effects in both groups.Material and method-In this prospective randomized controlled observer blinded study, 30 patients were taken up in each group belonging to ASA 1-2,age 18-60 years within 25% of ideal weight and height and posted for elective nephrectomy.Patients were divided into two groups:GROUP A: Patients received postoperative Single Thoracic Paravertebral Block(20 ml 0.25% Bupivacaine)+GA+PCA with iv fentanyl(2 mcg/ml) with basal infusion at the rate of 20 mcg/ml, Demand dose was 12 mcg with lockout interval of 20 minutes.GROUP B: Patients received GA+PCA with iv fentanyl (2 mcg/ml) with basal infusion at the rate of 20 mcg/ml, Demand dose was 12 mcg with lockout interval of 20 minutes.In addition rescue analgesia with inj.Tramadol 50-100 mg IV was given on VAS score >3.In postoperative period we assess duration of analgesia, VAS, NRS, RSS, time of first requirement of rescue analgesic, total consumption of fentanyl, total consumption of antiemetic and any complication in postoperative period.Results-Both the group were comparable and there was no statistically significant difference between the group, with respect to demographic characteristics of age, gender, height, weight ASA grading, blood loss during surgery, type, side and duration of surgery.Conclusion-Thoracic paravertebral block using bupivacaine was an effective regional technique with low fentanyl consumption, prolong postoperative analgesia, better hemodynamic stability, good pre-emptive effect, high patients satisfaction and minimal incidence of side effect in postoperative pain management of patients undergoing nephrectomy.