Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repair P. BHATTACHARYA, M. C. MANDAL, S. MUKHOPADHYAY, S. DAS, P. P. PAL and S. R. BASU Department Of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India Background: Inguinal herniorrhaphy can be successfully performed using general, regional or local anaesthesia. Paravertebral block (PVB) has been used for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia repair or renal surgery. Methods: We compared unilateral lumbar PVB with con- ventional spinal anaesthesia (SA) in 60 consenting ASA I and II males aged 18–65 years, scheduled for unilateral inguinal hernia repair. Patients were randomly assigned into two groups, P ( n 5 30) or S (n 5 30) to receive either PVB or SA, respectively. Two patients (7%) in group P had to be converted to general anaesthesia due to block failure. During surgery, patients of both groups received intrave- nous infusion of propofol titrated to light sedation. Results: The time to first post-operative analgesic require- ment (primary outcome measure) as 342  73 min in group P and 222  22 min in group S ( P o0.0001). Time to ambu- lation was 234  111min in group P and 361  32 min in group S (P o0.0001). Urinary retention requiring catheter- ization were found in zero (0%) patients in group P compared with five (16%) in group S ( P 5 0.024). Conclusion: It can be concluded that unilateral PVB is more efficacious than conventional SA in terms of prolong- ing post-operative analgesia and reducing morbidities in patients undergoing elective unilateral inguinal hernia repair. Accepted for publication 28 July 2009 r 2009 The Authors Journal compilation r 2009 The Acta Anaesthesiologica Scandinavica Foundation I NGUINAL herniorrhaphy is one of the most fre- quently performed surgeries and can be success- fully performed using general, regional or local anaesthesia. A good percentage of this surgery is done on an outpatient basis. The choice of anaes- thetic technique depends on patient and surgeon preference, feasibility of the technique in a given patient, pain control, early recovery, monitoring requirements (e.g., ability to fast-track) and peri- operative costs. 1,2 Several surveys suggest that until the last decade, most anaesthesiologists chose general anaesthesia (GA) (60–70%) and far fewer chose centroneuraxial blocks (10–20%) or regional anaesthesia with sedation (5–15%) as the primary anaesthetic technique. 3,4 But nowadays, uncomplicated hernia repairs in adult patients are mostly accomplished under re- gional anaesthesia: central neuraxial block (CNB) and peripheral nerve block (PNB). In comparison with GA, both CNB and PNB are associated with reduced pain scores and decreased post-operative analgesic requirement. Again, PNBs have been shown to be advantageous over GA in decreasing the need for post-anaesthesia care unit (PACU) use and decreased post-operative nausea and vomiting (PONV) but CNB is not advantageous over GA in this context. 5 Moreover, the predominant post-op- erative side effects after inguinal herniorrhaphy are related to the effects of general and regional anaes- thesia on gastrointestinal and urinary bladder function and the occurrence of postural hypoten- sion (e.g., dizziness, nausea and vomiting). 4 In contrast, local infiltration anaesthesia provides ade- quate surgical conditions without inducing major organ dysfunction. 4 Paravertebral somatic nerve block produces ipsilateral segmental analgesia through injection of local anaesthetic onto the spinal nerve roots alongside the vertebral column. It is advocated predominantly for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia repair or renal surgery, although it can be used for bilateral surgeries as well. 6 The aim of this study was to evaluate the efficacy of unilateral paravertebral somatic nerve block in comparison with spinal anaesthesia (SA) in 246 Acta Anaesthesiol Scand 2010; 54: 246–251 Printed in Singapore. All rights reserved r 2009 The Authors Journal compilation r 2009 The Acta Anaesthesiologica Scandinavica Foundation ACTA ANAESTHESIOLOGICA SCANDINAVICA doi: 10.1111/j.1399-6576.2009.02128.x