Paravertebral blocks for post-operative analgesia for robotic-assisted partial nephrectomy: a retrospective review

The interest in opiate-sparing analgesic techniques for post-operative pain management is growing. However, the use of regional analgesic techniques for robotic-assisted surgery is not well established. This study aims to assess the postoperative analgesic efficacy of a paravertebral block (PVB) on post-operative pain scores and opioid consumption in patients undergoing robotic-assisted partial nephrectomies (RAPN).

This study was a retrospective analysis of patients who underwent an elective RAPN by a single surgeon from November 2018 to April 2022. A total of 200 patients (N=81 PVB, N=119 non-PVB) met inclusion criteria for further evaluation. Baseline demographics, analgesic data, and outcomes were collected. Comparisons of outcomes between the PVB and non-PVB groups were made using unadjusted and multivariable regression models appropriate for the nature of the given outcome variable (continuous, ordinal, or count).

There were no significant differences between the studied groups regarding age, sex, American Society of Anesthesiology classification, anesthesia type (volatile vs. total intravenous). In comparison to patients without PVB, patients with PVB showed statistically significant lower post-anesthesia care unit (PACU) morphine equivalents (β: -2.43, P=0.006), a higher floor maximum pain score [odds ratio (OR): 2.41, P=0.001], and shorter PACU length of stay (β: -16.95, P=0.002). While these findings were statistically significant, these differences were small.

The addition of a PVB did not have a clinically significant impact on the immediate postoperative analgesic experience following RAPN.