Discussion
hypoesthesia, paravertebral block, Paravertebral block, numbness, pain
HEPATIC TUMOR
The study results showed that perioperative intermittent bolus paravertebral block could provide good anesthetic- and opioid-sparing effects, and enhance postoperative recovery both in-hospital and after discharge in patients undergoing open hepatectomy for hepatic tumor. Intermittent bolus paravertebral block reduced postoperative intravenous opioid consumptions, provided good postoperative analgesia, and reduced rates of hypoesthesia and numbness three months after discharge.Intermittent bolus paravertebral block reduces postoperative 48 h intravenous morphine consumption in patients undergoing open hepatectomy for hepatic tumor. A previous study using continuous infusion modality showed that opioid consumption was reduced by 21% at postoperative 24 h [Paravertebral block also had an impact on intraoperative hemodynamics and anesthetic management. A previous study on mastectomy and thoracoscopic surgeries showed that paravertebral block reduced intraoperative sevoflurane and opioid consumption, but changes in heart rate and blood pressure were not reported [To the best of our knowledge, the current literature does not include any study reporting the effects of paravertebral block on persistent post-surgical pain and recovery after discharge in hepatectomy. The reported effects of paravertebral block on persistent post-surgical pain in other types of surgeries were controversial [This study has several limitations. First, the early postoperative paravertebral analgesia effect was a dual effect of the initial loading dose and subsequent intermittent bolus dose, so it is unknown if a single injection could achieve a non-inferior analgesic effect. Second, to enable blinding, we did not assess the sensory blockade level after paravertebral block, hence the exact block range was unclear. However, considering that all the blocks were performed by an experienced anesthesiologist under ultrasound guidance, the chances of complete failure were low. Third, since major hepatectomy is associated with a decrease in ropivacaine clearance by > 50% after regional block (transverse abdominal plane block) [