DP68: PARAVERTEBRAL BLOCK IN OPEN PANCREATECTOMY SURGERY: A CASE SERIES EVALUATING PAIN, OPIOID USE, AND RECOVERY.
Fatima Serhan, MD; Hari Kalagara, MBBS, MD; Dennis J Warfield, MD
Mayo Clinic
Open pancreatic resections cause significant postoperative pain, increasing opioid consumption, side effects, and hospital stay (1). One randomized trial demonstrated that paravertebral block (PVB) reduced intraoperative and postoperative opioids compared to sham procedures (3). Systematic reviews comparing continuous thoracic PVB to epidurals showed similar outcomes (2). However, pooling continuous catheter and single-shot techniques limits evidence for single-shot PVB efficacy. We hypothesized that PVB would reduce 24-hour postoperative pain, opioid consumption, and hospital length of stay.
As this case series is devoid of patient identifiable information, it is exempt from IRB review requirements as per Mayo Clinic policy.
Data was extracted from electronic medical records (Epic) for adult patients undergoing open pancreatectomy at Mayo Clinic Florida from May 1st to December 3rd, 2025. Primary outcomes include opioid consumption (MMEs) and postoperative pain scores (NRS) during the first 24 hours, and hospital length of stay. Secondary outcomes include intraoperative opioid consumption, total opioid use from postoperative day 0 to 3, post anesthesia care unit (PACU) length of stay, incidence of postoperative nausea/vomiting and urinary retention, time to first bowel movement or flatus, and pain scores stratified by PVB level(s). Chronic opioid users or those receiving local anesthetic injections at the incision were excluded. Analysis controlled perioperative multimodal analgesic use to minimize confounding and was done using SPSS.
This retrospective study compared outcomes between patients who received a PVB (n=10) and those who did not (n=10) during thoracic surgery. The groups were demographically similar, with median ages of 71.5 and 74.5 years, respectively. All PVB patients received bilateral blocks, primarily at T7-T8/T8-T9 levels (60%). No statistically significant differences were observed between groups. Pain scores at PACU arrival (2.7 vs 3.8, p=0.072) and at subsequent postoperative timepoints showed trends favoring the PVB group but did not reach statistical or clinical significance. Hospital LOS was similar (7.1 vs 8.8 days, group=0.130). Postoperative opioid consumption within 24 hours was lower in the PVB group (90.9 vs 107.1 MME), though not statistically significant (p=0.705). For secondary outcomes, intraoperative opioid use (41.0 vs 43.0 MME, p=0.733) and time to first bowel movement or flatus (86.8 vs 64.6 hours, p=0.112) were comparable. Acetaminophen use was universal in both groups.
PVBs showed trends toward improved analgesia within 24 hours, but benefits diminished as blocks wore off, suggesting a potential rebound effect while questioning the ideal analgesic approach. Since opioid consumption remained comparable after POD1, patients may benefit more from continuous catheter applications (i.e. epidural analgesia or PVB catheters) especially for procedures with anticipated prolonged operative time. The primary study limitation is the small sample size (n=20), significantly limiting statistical power to detect meaningful differences.