Impact of Thoracic Paravertebral Block on Postoperative Analgesia and Recovery in Daytime Laparoscopic Partial Adrenalectomy: A Randomized Clinical Trial.

Abstract

Purpose: The purpose of this study is to evaluate the effects of thoracic paravertebral block (TPVB) on postoperative analgesia and recovery quality in individuals undergoing daytime laparoscopic partial adrenalectomy.

Design: A prospective, randomized, double-blind study.

Methods: A total of 65 patients scheduled for daytime laparoscopic partial adrenalectomy were randomly assigned to the TPVB group or the control group. After surgery and before extubation, the patients in the TPVB group received TPVB, while those in the control group did not undergo the intervention. The primary outcome was the Quality of Recovery-15 assessed at 24 and 48 hours postoperatively. Secondary outcomes included postoperative pain intensity measured using the visual analog scale (VAS), cumulative sufentanil consumption, rescue analgesia rate, intake, feeling nauseated, emesis, exam, duration of symptoms scores, first flatus and defecation time, and the incidence of postoperative nausea and vomiting.

Findings: The TPVB group demonstrated significantly higher Quality of Recovery-15 scores at 24 and 48 hours after surgery compared with the control group (all P < .05). The sufentanil consumption within 48 hours after surgery was reduced in the TPVB group (P = .002), as was the rate of rescue analgesia within 48 hours (P = .045). VAS scores for pain at rest were significantly decreased in the TPVB group at 1, 6, 12, and 24 hours postoperatively (all P < .05), while VAS pain scores during coughing were lower at 1, 6, and 12 hours (all P < .05). The TPVB group also exhibited lower intake, feeling nauseated, emesis, exam, duration of symptoms scores at 12, 24, and 48 hours after surgery (all P < .05). The time to first flatus and defecation was shorter in the TPVB group compared with the control group (all P < .05). Furthermore, the incidence of postoperative nausea and vomiting was lower in the TPVB group compared with the control group (P = .035).

Conclusions: These results indicated that TPVB enhances postoperative analgesia, improves gastrointestinal function, and promotes the quality of recovery in patients undergoing daytime laparoscopic partial adrenalectomy.