Efficacy of Ultrasound-Guided Thoracic Paravertebral Block on Postoperative Quality of Recovery in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Double-Blind Placebo-Controlled Trial

Abstract

Purpose

This study aimed to examine the effectiveness of ultrasound-guided thoracic paravertebral block on postoperative quality of recovery in patients undergoing percutaneous nephrolithotomy.

Patients and Methods

In this randomized, double-blind, placebo-controlled trial, we enrolled patients scheduled for unilateral percutaneous nephrolithotomy. Patients were randomly allocated to receive thoracic paravertebral block either with 20 mL of 0.5% ropivacaine (PVB group) or an equal volume of saline (control group). The primary outcome was the quality of patient recovery at 24 h postoperatively, assessed using the 15-item Quality of Recovery scale. The secondary outcomes included the area under the curve of pain scores over time, time to first rescue analgesia, and postoperative 24 h morphine consumption.

Results

We analyzed the data of 70 recruited participants. The median Quality of Recovery-15 score at 24 h postoperatively was 127 (interquartile range, 117–133) in the PVB group, which was significantly higher than 114 (interquartile range, 109–122) in the control group, with a median difference of 10 points (95% confidence interval, 5–14; P<0.001). The area under the curve of pain scores over time was lower in patients receiving thoracic PVB than in those receiving saline block (P<0.001). The median time to first rescue analgesia in the PVB group (10.8 h, interquartile range 7.1–22.8 h) was longer than that in the control group (1.9 h, interquartile range 0.5–4.3 h) (P<0.001). Similarly, the median postoperative 24-hour morphine consumption was nearly half as low in the PVB group as in the control group (P<0.001). The occurrence of postoperative nausea and vomiting, and pruritus were significantly higher in the control group (P=0.016 and P=0.023, respectively).

Conclusion

Preoperative ultrasound-guided single injection of thoracic paravertebral block with ropivacaine improved the postoperative quality of recovery and analgesia in patients undergoing percutaneous nephrolithotomy.

Keywords:

• pain management
• quality of recovery
• regional anesthesia
• ultrasonography

Abbreviations

ASA, American Society of Anesthesiologists; AUC, area under the curve; BMI, body mass index; COPD, chronic obstructive pulmonary disease; PACU, post anesthesia care unit; PCNL, percutaneous nephrolithotomy; PCIA, patient-controlled intravenous analgesia; PONV, postoperative nausea and vomiting; PVB, paravertebral block; QoR-15, 15-item quality of recovery questionnaire; NRS, numerical rating scale.

Data Sharing Statement

The individual deidentified participant data used to support the findings of this study can be accessed by the corresponding author (Dr. Yusheng Yao, [email protected]).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest.

Additional information

Funding

This study was supported by the Natural Science Foundation of Fujian Province (grant number 2021J01378) and Medical Innovation Project of Fujian Province (grant number 2022CXA007).