Comparison of Paravertebral Block with Spinal Anaesthesia in Unilateral Inguinal Hernia Repair.

INTRODUCTION: Paravertebral block is a regional technique involving peripheral nerve stimulator guided injection of local anaesthetic 0.5% bupivacaine (isobaric) at T10 level and L1 level immediately lateral to vertebral column, into the space where spinal cord emerges from the intervertebral foramina and bifurcates into dorsal and ventral rami. This technique provides unilateral motor, sympathetic and prolonged sensory blockade. Spinal anaesthesia for inguinal hernioplasty is widely used which provides intense sensory and motor blockade. It suppresses the stress response to surgical intervention, decreases morbidity in high risk patients and enabling maintenance of analgesia in postoperative period, cardiovascular system specific adverse events such as arterial vasodilation. MATERIAL AND METHODS: This was a prospective, randomized, single blind, comparative study. Adult patients belonging to ASA Grade I and II between ages 18 to 65 years of both sexes undergoing elective unilateral inguinal hernia repair were enrolled in the study. Total 60 subjects were recruited & divided into two groups i.e. 30 subjects in each group. Group P- Peripheral nerve stimulator guided paravertebral block in unilateral inguinal hernia repair using 0.5% Bupivacaine (Isobaric). Group S-Spinal anaesthesia in unilateral inguinal hernia repair using 0.5% Bupivacaine (hyperbaric). RESULTS: In our study we found that mean time of onset of sensory block was significantly longer in Group P (5.80 ± 1.21min) as compared to Group S (3.00 ±00 min). The mean time to achieve maximum sensory level was longer in Group P (16.33±2.01min) as compared to Group S (4.00±0.00min). The mean time for onset of motor block in Group P(9.73±1.01min) was significantly longer than Group S (5.00±00 min). The mean duration of motor block was longer in Group S (210.53±14.0min) compared to Group P (196.67±16.31min). The mean time to achieve maximum motor level was longer in Group P (19.73±2.08min) compared to Group S (5.00±0.00min). Mean duration of surgery in Group P (82.33±10.40min) and in Group S (84.17±10.99min). CONCLUSION: After comparison of Peripheral nerve stimulator guided paravertebral block with spinal anaesthesia in unilateral inguinal hernia repair following conclusions were drawn: Two segment paravertebral block provides an excellent anaesthesia with unilateral motor, sympathetic and prolonged sensory blockade. Paravertebral block provides prolonged post-operative analgesia, better haemodynamic control and lesser incidence of side effects like urinary retention. [ABSTRACT FROM AUTHOR]