Paravertebral block in inguinal hernia surgeries: two segments or 4 segments?

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Surgical Procedures

Background:

• Paravertebral block (PVB) is utilized for anesthesia and analgesia in surgical procedures.
• Optimizing PVB techniques for specific surgeries like inguinal hernia repair is an ongoing area of research.

Purpose of the Study:

• To compare the efficacy and safety of a two-segment PVB (T10 and L1) versus a four-segment PVB (T10, T11, T12, and L1) for inguinal hernia surgeries.

Main Methods:

• Anatomic cadaver study to assess dye spread.
• Fifty patients undergoing inguinal hernia surgery were randomized into two groups: two-segment PVB (n=25) or four-segment PVB (n=25).
• Evaluated outcomes included anesthetic consumption, block application time, surgery start time, sensory block duration, pain scores, and complications.

Main Results:

• Anatomical study showed dye spread from T10 to L1, staining relevant nerves.
• Block application time was significantly shorter for the two-segment PVB (5 min) compared to the four-segment PVB (16 min).
• No significant differences were observed in anesthetic consumption, surgery start times, or patient satisfaction. Motor block and contralateral spread were rare and primarily associated with the four-segment technique.

Conclusions:

• A two-segment PVB is a viable alternative to a four-segment PVB for inguinal hernia repair.
• Reducing the number of injection segments in PVB may improve patient comfort and potentially lower complication rates.