Perioperative Continuous Thoracic Paravertebral Block Improves Patients Quality of Recovery After Open Hepatectomy: A Randomized, Double-blind, Placebo-Controlled Trial
Background: Continuous thoracic paravertebral block could provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesis that these effects may improve patient perception of quality of recovery after open hepatectomy. Methods: Seventy-six patients aged ≥18 years, ASA score of I-III, scheduled for an open hepatectomy were randomized to receive a continuous thoracic paravertebral block (loading dose of 25 ml of 0.5% ropivacaine, followed by 0.125 ml/kg of 0.2% ropivacaine every hour until 48 hours postoperatively) or 0.9% saline control using a right paravertebral catheter at the T8 level. All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was analyzed using Student’s t-test. Results: Seventy-three patients completed the study, including 36 in the continuous thoracic paravertebral block group and 37 in the control group. Compared to the control, the continuous thoracic paravertebral block group had significantly higher global Chinese 15-item Quality of Recovery scores on postoperative day 7, with a difference of -10.52 (95% confidence interval, -17.04 to -3.99; P = 0.002). Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (Ps < 0.05; P = 0.001), respectively, in the continuous thoracic paravertebral block group. Conclusion: Perioperative continuous thoracic paravertebral block improves quality of recovery in patients undergoing hepatectomy with a profound analgesic effect in the early postoperative period.