Paravertebral block using bupivacaine with/without fentanyl on postoperative pain after laparoscopic cholecystectomy: A double-blind, randomized, control trial


Department of Anesthesiology and Intensive Care Unit, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Postoperative pain is one of the most common complaints after elective laparoscopic cholecystectomy. The present study was aimed to evaluate the effect of paravertebral block using bupivacaine with/without fentanyl on postoperative pain and complications after laparoscopic cholecystectomy.
Materials and Methods: This study was done on 90 patients scheduled to undergo elective laparoscopic cholecystectomy. Patients were assessed in two groups: The case group received bupivacaine and fentanyl, and the control group received bupivacaine and normal saline. Primary outcomes were severity of postoperative pain at rest and during coughing. Secondary outcomes were postoperative cumulative morphine consumption and the incidence of side-effects.
Results: Pain score at rest before surgery, after recovery, hour-1 and hour-6 was not significantly different between the groups. But in hour-24 cases, the pain score during coughing was significantly higher than controls. Severity of pain at rest in time points was not different between groups. The frequencies (%) of moderate pain at mentioned times in case and control groups were 64, 31, 16, 9, 0 versus 67, 16, 7, 4, and 0, respectively. Pain score during coughing was lower in controls at hour-24 in comparison with cases, but in other time points was not significant. The control group significantly received more total dose of morphine in comparison with cases group. Nausea, vomiting and hypotension were similar in groups, but pruritus was significantly different between the groups.
Conclusion: Adding fentanyl to bupivacaine in paravertebral block did not significantly improve the postoperative pain and complications after laparoscopic cholecystectomy. However, further studies are needed to be done.


1. Gottschalk A, Smith DS. New concepts in acute pain therapy: Preemptive analgesia. Am Fam Physician 2001;63:1979-84.  Back to cited text no. 1
2. Woolf CJ. Evidence for a central component of post injury pain hypersensitivity. Nature 1983;306:686-8.  Back to cited text no. 2
3. Wall PD. The prevention of postoperative pain. Pain 1988;33:289-90.  Back to cited text no. 3
4. Agarwal A, Batra RK, Chhabra A, Subramaniam R, Misra MC. The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy. Saudi J Anaesth 2012;6:344-9.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5. Boddy AP, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: A systematic review and meta-analysis. Anesth Analg 2006;103:682-8.  Back to cited text no. 5
6. Lau H, Brooks DC. Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy. Arch Surg 2001;136:1150-3.  Back to cited text no. 6
7. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001;90:261-9.  Back to cited text no. 7
8. Abdulla S, Eckhardt R, Netter U, Abdulla W. A randomized double-blind, controlled trial on non-opioid analgesics and opioid consumption for postoperative pain relief after laparoscopic cholecystectomy. Acta Anaesthesiol Belg 2012;63:43-50.  Back to cited text no. 8
9. Salihoglu Z, Yildirim M, Demiroluk S, Kaya G, Karatas A, Ertem M, et al. Evaluation of intravenous paracetamol administration on postoperative pain and recovery characteristics in patients undergoing laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2009;19:321-3.  Back to cited text no. 9
10. Akaraviputh T, Leelouhapong C, Lohsiriwat V, Aroonpruksakul S. Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy: A prospective, randomized study. World J Gastroenterol 2009;15:2005-8.  Back to cited text no. 10
11. Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy: A systematic review and metaanalysis of randomized trials. Br J Anaesth 2006;96:418-26.  Back to cited text no. 11
12. Cheema SP, Ilsley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anaesthesia 1995;50:118-21.  Back to cited text no. 12
13. Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg 2000;90:642-8.  Back to cited text no. 13
14. Bilgin M, Akcali Y, Oguzkaya F. Extrapleural regional versus systemic analgesia for relieving post-thoracotomy pain: A clinical study of bupivacaine compared with metamizol. J Thorac Cardiovasc Surg 2003;126:1580-3.  Back to cited text no. 14
15. Carabine UA, Gilliland H, Johnston JR, McGuigan J. Pain relief for thoracotomy. Comparison of morphine requirements using an extrapleural infusion of bupivacaine. Reg Anesth 1995;20:412-7.  Back to cited text no. 15
16. Carretta A, Zannini P, Chiesa G, Altese R, Melloni G, Grossi A. Efficacy of ketorolac tromethamine and extrapleural intercostal nerve block on post-thoracotomy pain. A prospective, randomized study. Int Surg 1996;81:224-8.  Back to cited text no. 16
17. Deneuville M, Bisserier A, Regnard JF, Chevalier M, Levasseur P, Herve P. Continuous intercostal analgesia with 0.5% bupivacaine after thoracotomy: A randomized study. Ann Thorac Surg 1993;55:381-5.  Back to cited text no. 17
18. Eng J, Sabanathan S. Continuous extrapleural intercostal nerve block and post-thoracotomy pulmonary complications. Scand J Thorac Cardiovasc Surg 1992;26:219-23.  Back to cited text no. 18
19. Imbelloni LE, Fornasari M, Fialho JC, Sant'Anna R, Cordeiro JA. General anesthesia versus spinal block for laparoscopic cholecystectomy. Rev Bras Anestesiol 2010;60:264-73.  Back to cited text no. 19
20. Joshi GP, Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008;107:1026-40.  Back to cited text no. 20
21. Castillo-Garza G, Díaz-Elizondo JA, Cuello-García CA, Villegas-Cabello O. Irrigation with bupivacaine at the surgical bed for postoperative pain relief after laparoscopic cholecystectomy. JSLS 2012;16:105-11.  Back to cited text no. 21
22. Kehlet H, Gray AW, Bonnet F, Camu F, Fischer HB, McCloy RF, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 2005;19:1396-415.  Back to cited text no. 22
23. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: A critical assessment of the evidence. Anesthesiology 2006;104:835-46.  Back to cited text no. 23
24. Gupta A. Local anaesthesia for pain relief after laparoscopic cholecystectomy: A systematic review. Best Pract Res Anaesthesiol 2005;19:275-92.  Back to cited text no. 24
25. Jabbour-Khoury SI, Dabbous AS, Gerges FJ, Azar MS, Ayoub CM, Khoury GS. Intraperitoneal and intravenous routes for pain relief in laparoscopic cholecystectomy. JSLS 2005;9:316-21.  Back to cited text no. 25
26. Elhakim M, Amine S, Kamel S, Saad F. Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam on pain relief and bowel recovery after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2000;44:929-33.  Back to cited text no. 26
27. Navlet MG, Garutti I, Olmedilla L, Pérez-Peña JM, San Joaquin MT, Martinez-Ragues G, et al. Paravertebral ropivacaine, 0.3%, and bupivacaine, 0.25%, provide similar pain relief after thoracotomy.J Cardiothorac Vasc Anesth 2006;20:644-7.  Back to cited text no. 27
28. Awwad ZM, Atiyat BA. Pain relief using continuous bupivacaine infusion in the paravertebral space after loin incision. Saudi Med J 2004;25:1369-73.  Back to cited text no. 28
29. Bhuvaneswari V, Wig J, Mathew PJ, Singh G. Post-operative pain and analgesic requirements after paravertebral block for mastectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl. Indian J Anaesth 2012;56:34-9.  Back to cited text no. 29
[PUBMED]  Medknow Journal  
30. Naja MZ, Ziade MF, Lönnqvist PA. General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: A prospective, randomized clinical trial. Eur J Anaesthesiol 2004;21:489-95.  Back to cited text no. 30
31. Burlacu CL, Frizelle HP, Moriarty DC, Buggy DJ. Fentanyl and clonidine as adjunctive analgesics with levobupivacaine in paravertebral analgesia for breast surgery. Anaesthesia 2006;61:932-7.  Back to cited text no. 31