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Created July 17, 2019, last updated about 4 years ago.
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Knowledge, pearl, summary or comment to share?Collected Articles
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Journal of endourology · Dec 2009
Paravertebral block provides significant opioid sparing after hand-assisted laparoscopic nephrectomy: an expanded case report of 30 patients.
We report our experience of paravertebral block (PVB) on analgesic requirements and dynamic pain in patients presenting for hand-assisted laparoscopic nephrectomy (HALN) and compare our results with conventional opioid therapy. ⋯ PVBs provided excellent analgesia with significant opioid sparing in this pilot series of 30 patients with HALN. Utilization of multimodal analgesia incorporating PVB is recommended for patients presenting for HALN.
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Randomized Controlled Trial
Thoracic paravertebral block for nephrectomy: a randomized, controlled, observer-blinded study.
This study evaluated whether adding a preoperative single thoracic paravertebral block (TPVB) to intravenous patient-controlled analgesia (IV PCA) would improve postoperative analgesia compared with using IV PCA alone in patients undergoing nephrectomy. ⋯ A preoperative single TPVB improved postoperative analgesia by reducing the postoperative pain score and fentanyl consumption in patients undergoing nephrectomy.
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Open surgical procedures are associated with substantial postoperative pain; an alternative method providing adequate pain relief with minimal side effects is very much required. ⋯ Continuous thoracic PVB is as effective as continuous thoracic EA in providing pain relief in patients undergoing open nephrectomy in the postoperative period. The side effect profile of the two techniques was also similar.
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Review Meta Analysis Comparative Study
A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials.
Epidural analgesia is considered by many to be the best method of pain relief after major surgery. It is used routinely in many thoracic surgery centres. Although effective, side-effects include hypotension, urinary retention, incomplete (or failed) block, and, in rare cases, paraplegia. ⋯ Rates of failed block were lower in the PVB group, OR 0.28 (0.2, 0.6). PVB and epidural analgesia provide comparable pain relief after thoracic surgery, but PVB has a better side-effect profile and is associated with a reduction in pulmonary complications. PVB can be recommended for major thoracic surgery.
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Daniel Jolley