BILATERAL PARAVERTEBRAL ANALGESIA FOR MAJOR ABDOMINAL VASCULAR-SURGERY - A PRELIMINARY-REPORT

Paravertebral analgesia is highly effective in blocking unilateral aff erent input from the trunk, but its bilateral use does not appear to h ave been described. Eight patients undergoing major abdominal vascular surgery had pre-operative bilateral paravertebral catheters inserted. A nose of 25 ml of bupivacaine 0.5% divided between the two catheters provided the basis of an effective intra-operative analgesic regimen which was continued postoperatively, by infusion of bupivacaine for 4 days. Diclofenac and morphine completed a balanced analgesic regimen w hich was started pre-operatively and continued for 5 and 3 days respec tively. Cardiovascular stability was notable throughout surgery, even with aortic clamping and all patients were extubated at the end of sur gery. Good quality analgesia was obtained as assessed by low postopera tive pain scores at rest and on movement. Three patients were not admi tted to the intensive care unit, where mean stays for the group was 10 h (range 0-24 h) and mean hospital stay was 10 days (range 7-14). The re were no additional demands made on the nursing staff and no postope rative pain-related complications occurred. We conclude that bilateral paravertebral analgesia, as part of a balanced analgesic technique, i s an alternative method of providing effective afferent blockage for m ajor abdominal surgery.