Bilateral paravertebral block reduces complications after pancreatectomy in retrospective cohort analysis

To investigate the effects of paravertebral block (PVB) on postoperative pancreatic fistula (POPF) and major complications in adult pancreatic surgery. All data of patients who underwent pancreatic surgery at Changhai hospital between January 2017 and June 2021 were retrieved. According to whether they received PVB or not, the patients were divided into the PVB and non-PVB groups. POPF-related factors were balanced by covariate balancing propensity score (CBPS) based inverse probability weighting. After that, the POPF and postoperative major complications between the two groups were compared. Another propensity score matching, multivariate logistic regression and instrumental variable regression were employed for sensitivity analysis. Results of sensitivity analysis were expressed as relative risk (RR) or odd ratio (OR) and 95% confidence interval (CI). A total of 3360 patients were included in the study, with 374 patients in PVB group and 2986 patients in non-PVB group. After CBPS, there was no significant difference in incidence (5.7% VS 6.2%, P = 0.785) between the groups (PVB VS non-PVB). Postoperative nasogastric tube retention time (2d VS 3d, P < 0.001), and length of hospital stay (11d VS 12d, P = 0.031) were significantly reduced in the PVB group. delayed gastric emptying (DGE) (RR 0.476; 95% CI 0.262-0.863; P = 0.014) and postpancreatectomy hemorrhage (PPH) (RR 0.426; 95% CI 0.287-0.630; P < 0.001) were reduced more than 50% in PVB group. PVB did not increase the risk of POPF, but reduced DGE and PPH by more than 50%, and improved postoperative recovery after pancreatectomy.