Effects of Intermittent Bolus Paravertebral Block On Analgesia and Recovery in Open Hepatectomy: A Retrospective, Cohort Study.

Abstract Background Experiences of paravertebral block use in hepatectomy were limited. We aimed to investigate the effects of intermittent bolus paravertebral block on analgesia and recovery in hepatectomy. Methods We selected patients receiving two types of analgesia programs, with matched age, sex and body mass index from a prospective perioperative analgesia and nerve block database: (1) PVB: intermittent bolus paravertebral block (0.5% ropivacaine 25ml before surgery plus 0.125ml•kg− 1 0.2% ropivacaine bolus per hour after surgery) and self-controlled intravenous bolus morphine pump till postoperative 48 hours; (2) control: self-controlled intravenous bolus morphine pump till postoperative 48 hours. The baseline, operation, and postoperative analgsia and recovery data were compared between groups. Results Thirty-eight patients in each group were included in the analysis. Intraoperatively, PVB group used less sevoflurane (difference − 0.1 (-0.2, 0.0) %, P = 0.019), and more ephedrine (U = 986, P = 0.004) and crystalloid (U = 936, P = 0.024) than control group. The mean arterial pressure in PVB group was lower than that in control group (difference − 4mmHg, 95%CI -8 ~ 0mmHg, P = 0.031) but similar to its baseline level (difference 2, 95%CI -1 ~ 5, P = 0.153). Postoperatively, PVB group had lower cumulative morphine consumption at postoperative 2 (U = 371.5, P < 0.001), 4 (U = 349.5, P < 0.001), 12 (U = 342.0, P < 0.001), 24 (U = 338.5, P < 0.001) and 48 (U = 392.5, P = 0.001) hour, lower pain numerical rating scale score at rest at postoperative 0 (U = 299.5, P < 0.001), 2 (U = 355.5, P < 0.001) and 4 (U = 332.0, P < 0.001) hour, and on movement at postoperative 0 (U = 269.5, P < 0.001), 2 (U = 405.0, P = 0.001), 4 (U = 382.5, P < 0.001) and 12 (U = 1179.5, P = 0.003) hour than control group. PVB group also had lower rescue analgesia rates (OR 0.29, 95%CI 0.08 ~ 1.00, P = 0.044), higher emergence satisfaction (5 (4, 5) vs 4 (4, 5), P = 0.018) and lower drowsiness score (0 (0,1) vs 1(0,1), P = 0.007) than control group. Three months postoperatively, PVB group had lower rates of hypoesthesia (OR 0.28 (0.11, 0.75), P = 0.009), numbness (OR 0.26 (0.07, 0.88), P = 0.024) and sleep disorder (OR 0.84 (0.73, 0.97), P = 0.025) than control group. Conclusions Intermittent bolus paravertebral block provided anesthetics- and opioids-sparing effects, and enhanced recovery both in hospital and after discharge in patients receiving hepatectomy.