P026: PARAVERTEBRAL BLOCK REDUCES POSTOPERATIVE OPIOID REQUIREMENTS IN PATIENTS UNDERGOING COMPLEX ABDOMINAL AORTIC ANEURYSM REPAIR
Cody B Jackson, PhD1; Jamshed Desai, BS1; Dan Naus, MS2; W Anthony Lee, MD1; Leslie Renfro, MD1; 1Charles E. Schmidt College of Medicine, Florida Atlantic University; 2Boca Raton Regional Hospital
INTRODUCTION: Open abdominal aortic aneurysm (AAA) repairs are associated with significant pain and morbidity. Previous studies have demonstrated utility of adjunctive epidural analgesia (EA) in addition to general anesthesia (GA) to reduce perioperative complications in patients undergoing elective AAA repair, owing to decreased pain and blunting of the maladaptive surgical stress response. However, EA is associated with several complications, such as epidural hematoma and severe hypotension secondary to bilateral sympathetic blockade. Therefore, recent reports have promoted the use of paravertebral block (PVB) as adjunctive anesthesia for open AAA repair. Advantages of PVB include unilateral localization, decreased risk for hypotension, and less concern for epidural hematoma in light of intraoperative systemic heparinization. In this study, we investigate the efficacy of PVB via a catheter placed in the left T10 paravertebral space, based on total opioid consumption, in the postoperative period.
METHODS: In this retrospective cohort study, charts of patients who underwent open retroperitoneal AAA repair between August 2021 and December 2021 were reviewed. Five patients treated with GA alone and 5 patients treated with GA+PVB were selected and compared with regards to total opioid analgesics administered during their entire in-hospital postoperative course. Doses were converted to morphine milligram equivalents (MME). Significance of means was calculated using an unpaired t-test.
RESULTS: Patients who did not undergo PVB required 36.8, 71.1, 72.8, 132, and 139.7 MME (mean ± SD, 90.5 ± 43.9) in the postoperative period. In contrast, patients who received PVB required 10.1, 12.6, 35.9, 42.6, and 46 MME (mean ± SD, 29.4 ± 16.9) (p=0.0199).
DISCUSSION: Decreased opioid analgesic requirements in the postoperative period suggest that PVB provides superior pain management compared to systemic opioids alone. While the present study is limited by retrospective design, the results provide a compelling equipoise for a future randomized controlled trial in assessing the benefit of PVB for AAA repair.