OPIOID SAVING STRATEGY: BILATERAL SINGLE-SITE THORACIC PARAVERTEBRAL BLOCK IN RIGHT LOBE DONOR HEPATECTOMY

Background and Objectives: Postoperative analgesia after hepatectomy remains a challenge, mainly because of limited therapeutic index of the conventional opioids. The aim of this study is to evaluate the efficacy of bilateral single-site thoracic paravertebral block for the management of postoperative pain following right lobe donor hepatectomy (RLDH) using a prospective, randomized and controlledstudy design. Methods: Twenty four adult patients, aged 18-50 years, ASA-I-II, of both sexes scheduled for right lobe donor hepatic resection, were enrolled in this study. Patients were randomly allocated into 2 equal groups of 12 patients each. Before induction of general anesthesia, allpatients received bilateral single-site thoracic paravertebral injection at the level of T7-8 in the sitting position. Patients of Group B were injected with 25 mL of bupivacaine 0.25% with epinephrine 1:200.000 on each side. Patients of Group P were injected with 25 mL of 0.9% NaCl (placebo). General anesthesia was standardized in all patients. Postoperative pain score, analgesic requirements and the incidence of postoperative nausea and vomiting were recorded. Results: Bilateral single-site thoracic paravertebral block significantly decrease the pain visual analogue score parameters. Total morphine consumption in the first 24 hours postoperatively was decreasedby more than 50% in Group B (21.76 ± 6.8 mg compared to 44.12 ± 9.2 mg in Group P).There was significant prolongation in time to rescue analgesia (104.08 ± 2.04 min in Group B, and 31.5 ± 6.14 min in Group P). Postoperative nausea and vomiting was significantly less in the active Group B when compared to the controlled Group P. Conclusion: Bilateral single-site thoracic paravertebral block is easy, safe and efficient technique for postoperative pain management in patients undergoing right lobe donor hepatectomy.