The efficacy of the ultrasound-guided retrolaminar block versus the classic paravertebral block in patients undergoing unilateral inguinal hernioplasty: a randomized controlled study | Revista Española de Anestesiología y Reanimación (English Edition)

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Eldadamony Mohammed, M. Nashaat Mohammed, M. Gad Mostafa, O. Bahy, A. elsaid Rashad" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Z." "apellidos" => "Eldadamony Mohammed" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Nashaat Mohammed" "email" => array:1 [ 0 => "moh_nashaat@mans.edu.eg" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Gad Mostafa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "O." "apellidos" => "Bahy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "elsaid Rashad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Lecturer of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Mansoura, Egypt" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Assistant Professor of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Egypt" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Lecturer of Surgical Oncology, Mansoura University, Mansoura, Egypt" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia del bloqueo retrolaminar ecoguiado frente al bloqueo paravertebral clásico en pacientes sometidos a hernioplastia inguinal unilateral: estudio controlado aleatorizado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1442 "Ancho" => 2494 "Tamanyo" => 132275 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Changes in HR." ] ] ] "textoCompleto" => "IntroductionA groin or inguinal hernia is a common surgical entity frequently diagnosed and operated in general surgery.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Although inguinal hernioplasty procedures are not often associated with extensive tissue dissection, about half of the patients report pain of moderate to severe intensity.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Regional nerve blocks, primarily when delivered under ultrasonographic guidance, are associated with more significant postoperative analgesia. These options include caudal block, paravertebral block (PVB),<a class="elsevierStyleCrossRef" href="#bib0015">3</a> and one of the most scientific evidence and recommendation grade are transversus abdominis plane block (TAP),<a class="elsevierStyleCrossRef" href="#bib0020">4</a> and ilioinguinal iliohypogastric nerve block (IINB).<a class="elsevierStyleCrossRef" href="#bib0025">5</a>A modification of the PVB was described in 2006, in which the local anesthetic injectate is delivered to the plane between the deep paraspinal muscles and the vertebral laminae. That block was named "Retrolaminar block."<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Inguinal hernioplasty patients have not been the subject of prior research comparing PVB with RLB in Egyptian or international settings. That was a legitimate reason for us to carry out the current study, which compared the analgesic effectiveness of the two blocks in patients undergoing elective inguinal hernia repair.Materials and methodsThis randomized prospective double-blinded trial was conducted over five months, from January 2023 to May 2023. The trial was designed for adult patients between 20 and 60 years diagnosed with unilateral inguinal hernia and scheduled for elective open inguinal hernioplasty. We did not start patient evaluation or enrollment until we obtained ethical approval from our Institutional Review Board (IRB code: R.22.12.2001.R1). This study followed the World Medical Association's Declaration of Helsinki Code of Ethics for human studies.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> This study followed the CONSORT statement and provided a complete CONSORT checklist.All patients received the proper preoperative evaluation. Patients with ASA class ≥ 3 and BMI > 30 were excluded from our study. We also excluded patients with any of the following criteria: emergency presentation, bilateral hernia, recurrent hernia, morbid obesity, bleeding diathesis, chronic opioid abuse, mental dysfunction, known allergy to the study drugs, or infection at the injection site.Fifty-six patients met our inclusion criteria. Enrolled patients were randomly allocated (1:1 allocation) into two equal groups, the PVB group (n = 28) and RLB (n = 28), according to the applied block procedure by computer–generated randomization table using the Statistical Package for the Social Sciences (SPSS) version 22 for Windows (IBM SPSS Inc, Chicago, IL, USA), The group's assignments were concealed in a sequential number of sealed and opaque envelopes. Before patient enrollment, the envelopes containing patient information were opened by an additional anesthesiologist unrelated to the research. Patients and the investigators were blind to the performed block. The patients in both groups signed a written consent documenting their approval to participate in the clinical research, along with each block's advantages and possible adverse events.The hernioplasty procedures were performed under general anesthesia. After standard hemodynamic monitoring, the anesthesia was induced by IV fentanyl (1 mcg/kg) as a single dose with induction and IV propofol (2–3 mg/kg), and endotracheal tube placement was facilitated by IV atracurium besylate (0.6 mg/kg). Dexamethasone (8 mg IV), ondansetron 4 mg, metoclopramide 10 mg IV as antiemetic prophylaxis, and paracetamol (1 g) were given to all patients following induction. Mechanical ventilation was adjusted to keep the patient's end-tidal CO2 between 30 and 35 mmHg. We maintained uniform depth of general anesthesia using isoflurane 1.2%, oxygen in room air mixture (40:60), and top-up doses of atracurium when required.The block procedures were performed according to group allocation and under ultrasound guidance (high-frequency curved transducer of Mindray ultrasound machine, Shenzhen Biomedical Electronics, China) at the T12 level. The blocks were performed on the same side of the planned operation when the patients had lateral decubitus before creating the skin incision. The T7 level was first identified (just opposite to the angle of the scapula), and then the spinous processes of the thoracic vertebrae were counted down until we reached the T12 level. The skin over the injection area was sterilized by povidone-iodine, and the ultrasound transducer was placed inside a sterile glove.In the PVB group, we placed the probe vertically over the patient's back, about 3 cm lateral to the thoracic spinous process. The following structures were identified: the parietal pleura, the costotransverse ligament, and the transverse process of the thoracic vertebrae. A sonovisible needle was inserted in a cephalad orientation, puncturing the superior costotransverse ligament and reaching the paravertebral space. After a negative aspiration test, the block was performed using 20 ml of bupivacaine 0.25%.In the RLB group, the same ultrasound probe was placed in the same manner as before, about 1.5 cm lateral to the midline. The lamina of the T12 thoracic vertebra, representing the optimal needle-bone contact endpoint, was identified as a continuous hyperechoic structure. A sonovisible needle was inserted towards that lamina in a cephalad orientation until reaching that optimal contact point. The same volume and concentration of bupivacaine used in the PVB group was administered after a negative aspiration test. The time needed for both blocks was recorded, defined as the duration elapsed between the first needle entry and the completion of the block process.The procedures were performed after the block when the patient was supine. Hemodynamic parameters, including mean arterial pressure and heart rate (MAP and HR), were recorded at baseline, intubation, skin incision, traction of the hernial sac, and end of the hernioplasty procedure. After the skin incision was closed, IV atropine (0.02 mg/kg) and IV neostigmine (0.05 mg/kg) were administered to reverse the anesthesia. The patients were then transferred to the PACU, and their VAS was recorded (0 -h VAS) when they became responsive to verbal commands. Although the anesthesiologists who performed the block were aware of group allocation, the other anesthesiologists who collected intraoperative and postoperative data were blinded by group allocation.During the postoperative period, all patients were commenced on IV acetaminophen (1 gm/8 h). During their stay in the general surgical ward, the VAS was recorded every two hours for the first eight hours after the procedure, and then it was recorded at 12, 18, and 24 h after the procedure. Any breakthrough pain (VAS ≥ 4) was managed by IV morphine (3 mg), based on the data published by Kapfer et al.,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> who recommended that dose for perioperative pain management in adults, which was repeated every five minutes until pain resolved, or adverse event occurred (e.g., respiratory depression). The duration till the first call for opioid intake was recorded and taken as our primary outcome. Most patients were discharged after 24 h and asked to express their satisfaction with their analgesic regimen on a five-degree Likert scale (from highly satisfied to highly unsatisfied).<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Study outcomesOur primary outcome was the time until the first analgesic rescue. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24 -h morphine consumption, the level of patient satisfaction, and the incidence of block-related complications.Sample size calculationWe used the PASS software for Windows (version 15.0.5) to calculate the proper sample size. We used the data published by Sugiyama and his colleagues, who compared the same two blocks in patients undergoing thoracoscopic procedures. These authors reported that the duration passed to the first call for opioid intake was 45 min in the PVB group and 22 min in the RLB group.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Based on the previous data, we assumed that the expected difference between the two groups was 20 min. Therefore, the minimal required sample size was estimated to be 28 cases in each group to achieve a 0.05 significance level and 80% study power.Statistical analysisThe SPSS software (version 26) for MacOS was used to analyse the previously collected data. To test the normality of data distribution Shapiro-Wilk test was done. We applied the student t-test for comparison between the collected non-skewed quantitative parameters (means and standard deviations). Additionally, the Mann-Whitney test was applied for comparison between the collected skewed quantitative data (medians and ranges). Furthermore, the Chi-Square test was used for comparison between the collected categorical variables (numbers and percentages). Any obtained p-values less than 0.05 were considered statistically significant.ResultsThe demographic patients' criteria did not express statistical differences between our groups. That was the same for hernia characteristics (laterality and type) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The time needed for block installation was 3.52 ± 0.7 min in the PVB group and 1.13 ± 0.24 in the RLB group (p < 0.001). The two groups had comparable operative times (p = 0.562) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The recorded MAP and HR readings showed no statistical differences between the two study groups. (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). During the first six hours after the surgical procedure, the recorded pain scores showed no statistical difference between the two groups, neither at rest nor during movement. However, the RLB had higher ranges compared to the PVB group. The eight-hour reading and the subsequent ones showed significant elevation in the RLB group (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>)<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>As shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>, we noticed a significant prolongation of the time to the first call for opioid analgesia in the PVB group (median = 18 vs. 12 h in the RLB group). Additionally, morphine consumption significantly decreased in the same group (median = 3 vs. 6 mg in the RLB group). Although patient satisfaction did not differ statistically between our groups, the PVB group had a higher percentage of satisfied subjects. The incidence of GIT adverse events (nausea and vomiting) was statistically comparable between the two groups, and no block-related complications( pneumothorax, hemothorax, intrathecal spread,….etc) were encountered in our study.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionTo our knowledge, a significant advantage of current research is that this is the first study to assess the analgesic efficacy of RLB and PVB in individuals undergoing elective inguinal hernioplasty. In our study, we preferred to install either block technique before the skin incision, as we strongly believe in "preemptive analgesia." Preemptive analgesia prevents the transmission of nociceptive impulses, inhibiting both central and peripheral sensitization.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> That makes it more effective than block installation after the surgical trauma.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>Our findings revealed that PVB is an effective option for perioperative pain management in inguinal hernioplasty patients. That was evident in the stable intraoperative hemodynamics, low average postoperative VAS, modest morphine requirements, and excellent patient satisfaction with no incidence of opioid-related complications.Multiple trials have confirmed the efficacy of PVB in providing and maintaining analgesia not only after hernial repair procedures but also after other abdominal surgeries like cholecystectomy,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> hepatectomy,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> gynecological,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> and urological procedures.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> The analgesic action of PVB could be explained by the effect of the local anesthetic injectate in the paravertebral space, along with its extension to the epidural and intercostal spaces. Also, systemic absorption of these local anesthetics may play a role.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Our research discovered that RLB's ability to provide postoperative analgesia was far behind PVB's. This was reflected in the RLB group's shorter time to the initial opioid call, more opioid use, and greater pain levels.The RLB was first described by Pfeiffer in 2006, who did this block using the landmark technique without using ultrasound guidance.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> That block targets the vertebral laminas posterior surface and could be applied in cervical, thoracic, or lumbar regions.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>The mechanism of analgesia provided by the RLB is quite similar to the PVB, as the injectate spreads to the paravertebral, intercostal, and epidural spaces and the intervertebral foramina.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a> Nonetheless, the injectate spread is limited compared to the PVB.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> That could be explained by the facet joint capsule, lamina, and spinous process, which act as anatomical barriers hindering the free spread of the injectate.<a class="elsevierStyleCrossRefs" href="#bib0090">18,20</a> That could explain the lower analgesic outcomes in our RLB group compared to the PVB one.Wang and his associates confirmed the superiority of PVB against RLB in their lung cancer patients undergoing thoracoscopic surgery. The measured postoperative VAS had significantly lower values in the PVB group at rest (for the initial 48 h) and during cough (for the initial 36 h) compared to the RLB group.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>In mastectomy patients, Murouchi and Yamakage compared the same two blocks (but continuously rather than a single bolus injection). Postoperative pain was compared using the amount of block PCA (3 ml 0.25% levobupivacaine with 30-min lockout). The frequency of block patient-controlled analgesia was higher in association with the RLB(6 vs. 2.5 in the PVB group). The remifentanil dose was higher in the RLB group (0.06 vs. 0.01 µg/kg/min in the PVB group).<a class="elsevierStyleCrossRef" href="#bib0110">22</a>Furthermore, Sugiyama et al. found that postoperative VAS was higher in the RLB group compared to the PVB group in their patients undergoing thoracoscopic procedures when patients with longer incisions were excluded.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> In the same context, Onishi et al. reported that RLB provided Analgesia for only 2–3 hours after mastectomy procedures, which is significantly shorter than the reported analgesic period provided by PVB.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>We noted only one advantage for the RLB, which is the easy application, which was reflected in the time to perform the block. It was significantly shorter than the time needed for the PVB. Multiple studies reported that that block took less time than the PVB. Perhaps because of its prominent bonny landmark, the injection location is more easily accessible, and the block takes less time to complete.<a class="elsevierStyleCrossRefs" href="#bib0050">10,18</a>Our findings showed a slight increase in the incidence of GIT adverse events in the RLB group without reaching a statistical significance level. That could be secondary to the increased pain severity or increased opioid intake in the same group compared to the other.We did not encounter any block-related adverse events with the two block procedures. That could be secondary to the performance of both blocks under ultrasound guidance, which increases the accuracy of delivery of the injectate to the required plane without injury to the surrounding neurovascular structures.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>The better perioperative analgesic profile and lower incidence of complications led to better patient satisfaction in the PVB group, which was manifested by the rise in the percentage of patients reporting "very satisfied" or "satisfied" status.LimitationsOur trial handled a unique research point. However, it has some drawbacks. We included a relatively small patient sample collected from a single hospital. Also, we should have evaluated the effect of these blocks on the incidence of chronic postsurgical inguinal pain (inguinodynia). No comparison was made with other ultrasound-guided peripheral blocks; it would be helpful if further studies involved these issues. The age range selected for our institute's protocol is 20–60. This is because those 18 years or under are considered part of the kid population and are directed to a children's hospital. The higher incidence of inguinal hernia in males results in a more significant number of male patients. We eliminated patients classified as ASA III due to the potential interference of severe medical conditions with the study's anesthesia protocol. Additionally, patients with poorly controlled diabetes may experience neuropathy, which could introduce bias into the results.ConclusionThe PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption.Author contributions<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Study conception and design: Aly E. Rashad, Mohammed Nashaat Mohammed, Mona Gad, Osama Bahy.</li><li class="elsevierStyleListItem" id="lsti0010">•Acquisition of data: Aly E. Rashad, Mona Gad, Zenat Eldadamony.</li><li class="elsevierStyleListItem" id="lsti0015">•Analysis and interpretation of data: Aly E. Rashad, Mohammed Nashaat Mohammed, Mona Gad.</li><li class="elsevierStyleListItem" id="lsti0020">•Critical revision of the manuscript: Aly E. Rashad, Zenat Eldadamony, Mona Gad, Osama Bahy.</li></ul>The manuscript has been read and approved by all authorsThis manuscript has not been submitted for publication in any other journal. It will not subsequently be submitted for potential publication in another journal until a decision has been made, nor has it been published previously in any media.Iranian clinical trial IDIRCT20220212054002N2 <a href="https://www.irct.ir/trial/68066">https://www.irct.ir/trial/68066</a>.Conflicts of interestNone.Financial disclosuresNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:19 [ 0 => array:3 [ "identificador" => "xres2260302" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1885930" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2260301" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1885931" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Study outcomes" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Sample size calculation" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Limitations" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Author contributions" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Iranian clinical trial ID" ] 15 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 16 => array:2 [ "identificador" => "sec0065" "titulo" => "Financial disclosures" ] 17 => array:2 [ "identificador" => "xack778683" "titulo" => "Acknowledgement" ] 18 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-11-21" "fechaAceptado" => "2024-01-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1885930" "palabras" => array:3 [ 0 => "Paravertebral block" 1 => "Retrolaminar block" 2 => "Inguinal hernioplasty" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1885931" "palabras" => array:3 [ 0 => "Bloqueo paravertebral" 1 => "Bloqueo retrolaminar" 2 => "Hernioplastia inguinal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundIn daily surgical practice, inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain. Multiple regional blocks have been described for analgesia after such operations. Retrolaminar block (RLB) is a paravertebral block (PVB) variant that provides excellent analgesia and reduces the risk of complications. This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty. MethodsThe 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level: PVB group (28 patients) and RLB (28 patients). Time until the first rescue analgesia was our primary outcome. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24-h morphine consumption, the level of patient satisfaction, and the incidence of block-related complications. ResultsDemographic data were comparable in the two groups. However, the time needed for the block was significantly shortened with the RLB (p < 0.001). Patients in the PVB groups expressed better pain scores and lower opioid consumption. Additionally, the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB. There was no discernible difference in the frequency of adverse events and recorded MAP and HR. ConclusionThe PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption, with no significant increase in block-related complications." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa hernioplastia inguinal es un procedimiento quirúrgico común que está asociado frecuentemente a dolor postoperatorio severo. En este context, se han descrito muchos bloqueos regionales diferentes. El bloque retrolaminar (BRL) es una variante del bloqueo paravertebral (BPV) que aporta analgesia excelente y reduce el riesgo de complicaciones. Este estudio prospectivo compara la eficacia analgésica de BPV y BRL en la hernioplastia inguinal. MétodosSe aleatorizó a los 56 pacientes incluidos en dos grupos: el grupo BPV (28 pacientes) y el grupo BRL (28 pacientes). Todos los bloqueos nerviosos fueron realizados con guía ecográfica en T12. La medida del resultado primario fue el tiempo hasta la primera solicitud de analgesia de rescate. Los resultados secundarios incluyeron el tiempo necesario para realizar el bloqueo, los cambios de los parámetros hemodinámicos intraoperatorios, el dolor postoperatorio calificado con la escala visual analógica (EVA), el consumo de morfina durante 24 horas, la satisfacción del paciente, y la incidencia de complicaciones relacionadas con el bloqueo. ResultadosLos datos demográficos fueron similares en ambos grupos. El tiempo necesario para realizar el bloqueo fue significativamente menor en el grupo BRL (p < 0,001). Los pacientes del grupo BPV tuvieron menores puntuaciones EVA, menor consumo de opioides y un tiempo significativamente mayor hasta la solicitud de opioides de rescate. No existió diferencia discernible en cuanto a la frecuencia de episodios adversos y cambios de la presión arterial y frecuencia cardiaca. ConclusiónLos pacientes que recibieron BPV perioperatorios reflejaron un tiempo más prolongado hasta la primera solicitud de analgesia de rescate, menores puntuaciones para el dolor, menor consumo de opioides, y ausencia de incremento significativo de complicaciones relacionadas con el bloqueo, lo cual refleja que esta técnica es superior a BRL en la hernioplastia inguinal." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1387 "Ancho" => 2407 "Tamanyo" => 140445 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Changes in M.A.P." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1442 "Ancho" => 2494 "Tamanyo" => 132275 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Changes in HR." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data expressed as mean ±SD, number (%)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" colspan="2" style="border-bottom: 2px solid black">PVB Group (n = 28)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">RLB Group (n = 28)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P value</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upper \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.57 ± 8.60</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.29 ±10.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−3.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.621 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (100%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (96.43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.313 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (3.57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.64 ± 2.4</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.15 ± 2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.447 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASA status \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Class I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (71.43%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (64.29%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.567 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Class II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (28.57%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (35.71%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hernia side \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (57.14%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.592 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (42.86%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hernia type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Direct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (32.14%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indirect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (50%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (57.14%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.826 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (17.86%)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (17.86%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time to perform the block (min.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.52 ± 0.7</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.13 ± 0.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.680 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Operative time (min)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.32 ± 13.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.18 ± 14.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−5.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.562 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3675499.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline criteria of the study patients, time for the block procedures and the duration of surgery in the study groups." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data expressed as median (range)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PVB group (n = 28) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RLB group (n = 28) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PACU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.918 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.949 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.941 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.350 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.037* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (4–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001* \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3675500.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Postoperative pain scores during rest." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data expressed as median (range)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PVB group (n = 28) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RLB group (n = 28) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.808 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.941 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.227 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (4–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (4–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (5–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.013* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (5–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (5–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001* \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3675502.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Postoperative pain scores during ambulation." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data expressed as mean ±SD, number (%)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">PVB group (n = 28)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">RLB group (n = 28)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">P-value</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0 (0%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">0 (0%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time to the first rescue analgesia (hours) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (6–18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (4–18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morphine consumption during 24 h (mg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (3–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−2.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Satisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Highly satisfied \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (28.57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (21.43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.573 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Satisfied \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (35.71%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (28.57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neutral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (21.43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (21.43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unsatisfied \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (14.29%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (21.43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Highly unsatisfied \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7.14%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nausea and vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7.14%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (10.71%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.639 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block-related complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3675501.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Analgesic profile in the postoperative period, satisfaction, and incidence of complications in the study groups." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International guidelines for groin hernia management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.P. Simons" 1 => "M. Smietanski" 2 => "H.J. Bonjer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10029-018-1733-0" "Revista" => array:7 [ "tituloSerie" => "Hernia" "fecha" => "2018" "volumen" => "22" "numero" => "1" "paginaInicial" => "1" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29453501" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ilioinguinal/iliohypogastric nerve block versus transversus abdominis plane block for pain management following inguinal hernia repair surgery: a systematic review and meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Zhou" 1 => "M. Chen" 2 => "Y. 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Bai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000000835" "Revista" => array:7 [ "tituloSerie" => "Anesth Analg" "fecha" => "2015" "volumen" => "121" "numero" => "2" "paginaInicial" => "556" "paginaFinal" => "569" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26086619" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of transversus abdominis plane block on acute and chronic pain after inguinal hernia repair. A randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Theodoraki" 1 => "P. Papacharalampous" 2 => "A. Tsaroucha" 3 => "A. Vezakis" 4 => "E. 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Original article

The efficacy of the ultrasound-guided retrolaminar block versus the classic paravertebral block in patients undergoing unilateral inguinal hernioplasty: a randomized controlled study

Eficacia del bloqueo retrolaminar ecoguiado frente al bloqueo paravertebral clásico en pacientes sometidos a hernioplastia inguinal unilateral: estudio controlado aleatorizado

Z. Eldadamony Mohammeda, M. Nashaat Mohammeda,

Corresponding author

moh_nashaat@mans.edu.eg

Corresponding author.

, M. Gad Mostafab, O. Bahyc, A. elsaid Rashada

a Lecturer of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Mansoura, Egypt

b Assistant Professor of Anaesthesia, Pain Medicine and Surgical ICU, Mansoura University, Egypt

c Lecturer of Surgical Oncology, Mansoura University, Mansoura, Egypt

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A groin or inguinal hernia is a common surgical entity frequently diagnosed and operated in general surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although inguinal hernioplasty procedures are not often associated with extensive tissue dissection&#44; about half of the patients report pain of moderate to severe intensity&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Regional nerve blocks&#44; primarily when delivered under ultrasonographic guidance&#44; are associated with more significant postoperative analgesia&#46; These options include caudal block&#44; paravertebral block &#40;PVB&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and one of the most scientific evidence and recommendation grade are transversus abdominis plane block &#40;TAP&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and ilioinguinal iliohypogastric nerve block &#40;IINB&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A modification of the PVB was described in 2006&#44; in which the local anesthetic injectate is delivered to the plane between the deep paraspinal muscles and the vertebral laminae&#46; That block was named &#34;Retrolaminar block&#46;&#34;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Inguinal hernioplasty patients have not been the subject of prior research comparing PVB with RLB in Egyptian or international settings&#46; That was a legitimate reason for us to carry out the current study&#44; which compared the analgesic effectiveness of the two blocks in patients undergoing elective inguinal hernia repair&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This randomized prospective double-blinded trial was conducted over five months&#44; from January 2023 to May 2023&#46; The trial was designed for adult patients between 20 and 60 years diagnosed with unilateral inguinal hernia and scheduled for elective open inguinal hernioplasty&#46; We did not start patient evaluation or enrollment until we obtained ethical approval from our Institutional Review Board &#40;IRB code&#58; R&#46;22&#46;12&#46;2001&#46;R1&#41;&#46; This study followed the World Medical Association&#39;s Declaration of Helsinki Code of Ethics for human studies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This study followed the CONSORT statement and provided a complete CONSORT checklist&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients received the proper preoperative evaluation&#46; Patients with ASA class &#8805; 3 and BMI&#8239;&#62;&#8239;30 were excluded from our study&#46; We also excluded patients with any of the following criteria&#58; emergency presentation&#44; bilateral hernia&#44; recurrent hernia&#44; morbid obesity&#44; bleeding diathesis&#44; chronic opioid abuse&#44; mental dysfunction&#44; known allergy to the study drugs&#44; or infection at the injection site&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Fifty-six patients met our inclusion criteria&#46; Enrolled patients were randomly allocated &#40;1&#58;1 allocation&#41; into two equal groups&#44; the PVB group &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;28&#41; and RLB &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;28&#41;&#44; according to the applied block procedure by computer&#8211;generated randomization table using the Statistical Package for the Social Sciences &#40;SPSS&#41; version 22 for Windows &#40;IBM SPSS Inc&#44; Chicago&#44; IL&#44; USA&#41;&#44; The group&#39;s assignments were concealed in a sequential number of sealed and opaque envelopes&#46; Before patient enrollment&#44; the envelopes containing patient information were opened by an additional anesthesiologist unrelated to the research&#46; Patients and the investigators were blind to the performed block&#46; The patients in both groups signed a written consent documenting their approval to participate in the clinical research&#44; along with each block&#39;s advantages and possible adverse events&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The hernioplasty procedures were performed under general anesthesia&#46; After standard hemodynamic monitoring&#44; the anesthesia was induced by IV fentanyl &#40;1 mcg&#47;kg&#41; as a single dose with induction and IV propofol &#40;2&#8211;3&#8239;mg&#47;kg&#41;&#44; and endotracheal tube placement was facilitated by IV atracurium besylate &#40;0&#46;6&#8239;mg&#47;kg&#41;&#46; Dexamethasone &#40;8&#8239;mg IV&#41;&#44; ondansetron 4&#8239;mg&#44; metoclopramide 10&#8239;mg IV as antiemetic prophylaxis&#44; and paracetamol &#40;1&#8239;g&#41; were given to all patients following induction&#46; Mechanical ventilation was adjusted to keep the patient&#39;s end-tidal CO2 between 30 and 35&#8239;mmHg&#46; 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we placed the probe vertically over the patient&#39;s back&#44; about 3&#8239;cm lateral to the thoracic spinous process&#46; The following structures were identified&#58; the parietal pleura&#44; the costotransverse ligament&#44; and the transverse process of the thoracic vertebrae&#46; A sonovisible needle was inserted in a cephalad orientation&#44; puncturing the superior costotransverse ligament and reaching the paravertebral space&#46; After a negative aspiration test&#44; the block was performed using 20&#8239;ml of bupivacaine 0&#46;25&#37;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the RLB group&#44; the same ultrasound probe was placed in the same manner as before&#44; about 1&#46;5&#8239;cm lateral to the midline&#46; The lamina of the T12 thoracic vertebra&#44; representing the optimal needle-bone contact endpoint&#44; was identified as a continuous hyperechoic structure&#46; A sonovisible needle was inserted towards that lamina in a cephalad orientation until reaching that optimal contact point&#46; The same volume and concentration of bupivacaine used in the PVB group was administered after a negative aspiration test&#46; The time needed for both blocks was recorded&#44; defined as the duration elapsed between the first needle entry and the completion of the block process&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The procedures were performed after the block when the patient was supine&#46; Hemodynamic parameters&#44; including mean arterial pressure and heart rate &#40;MAP and HR&#41;&#44; were recorded at baseline&#44; intubation&#44; skin incision&#44; traction of the hernial sac&#44; and end of the hernioplasty procedure&#46; After the skin incision was closed&#44; IV atropine &#40;0&#46;02&#8239;mg&#47;kg&#41; and IV neostigmine &#40;0&#46;05&#8239;mg&#47;kg&#41; were administered to reverse the anesthesia&#46; The patients were then transferred to the PACU&#44; and their VAS was recorded &#40;0&#8239;-h VAS&#41; when they became responsive to verbal commands&#46; Although the anesthesiologists who performed the block were aware of group allocation&#44; the other anesthesiologists who collected intraoperative and postoperative data were blinded by group allocation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">During the postoperative period&#44; all patients were commenced on IV acetaminophen &#40;1&#8239;gm&#47;8&#8239;h&#41;&#46; During their stay in the general surgical ward&#44; the VAS was recorded every two hours for the first eight hours after the procedure&#44; and then it was recorded at 12&#44; 18&#44; and 24&#8239;h after the procedure&#46; Any breakthrough pain &#40;VAS&#8239;&#8805;&#8239;4&#41; was managed by IV morphine &#40;3&#8239;mg&#41;&#44; based on the data published by Kapfer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> who recommended that dose for perioperative pain management in adults&#44; which was repeated every five minutes until pain resolved&#44; or adverse event occurred &#40;e&#46;g&#46;&#44; respiratory depression&#41;&#46; The duration till the first call for opioid intake was recorded and taken as our primary outcome&#46; Most patients were discharged after 24&#8239;h and asked to express their satisfaction with their analgesic regimen on a five-degree Likert scale &#40;from highly satisfied to highly unsatisfied&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study outcomes</span><p id="par0070" class="elsevierStylePara elsevierViewall">Our primary outcome was the time until the first analgesic rescue&#46; Other outcomes included the time to perform the block&#44; changes in intraoperative hemodynamic parameters&#44; postoperative VAS&#44; 24&#8239;-h morphine consumption&#44; the level of patient satisfaction&#44; and the incidence of block-related complications&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sample size calculation</span><p id="par0075" class="elsevierStylePara elsevierViewall">We used the PASS software for Windows &#40;version 15&#46;0&#46;5&#41; to calculate the proper sample size&#46; We used the data published by Sugiyama and his colleagues&#44; who compared the same two blocks in patients undergoing thoracoscopic procedures&#46; These authors reported that the duration passed to the first call for opioid intake was 45&#8239;min in the PVB group and 22&#8239;min in the RLB group&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Based on the previous data&#44; we assumed that the expected difference between the two groups was 20&#8239;min&#46; Therefore&#44; the minimal required sample size was estimated to be 28 cases in each group to achieve a 0&#46;05 significance level and 80&#37; study power&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">The SPSS software &#40;version 26&#41; for MacOS was used to analyse the previously collected data&#46; To test the normality of data distribution Shapiro-Wilk test was done&#46; We applied the student t-test for comparison between the collected non-skewed quantitative parameters &#40;means and standard deviations&#41;&#46; Additionally&#44; the Mann-Whitney test was applied for comparison between the collected skewed quantitative data &#40;medians and ranges&#41;&#46; Furthermore&#44; the Chi-Square test was used for comparison between the collected categorical variables &#40;numbers and percentages&#41;&#46; Any obtained p-values less than 0&#46;05 were considered statistically significant&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The demographic patients&#39; criteria did not express statistical differences between our groups&#46; That was the same for hernia characteristics &#40;laterality and type&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The time needed for block installation was 3&#46;52&#8239;&#177;&#8239;0&#46;7&#8239;min in the PVB group and 1&#46;13&#8239;&#177;&#8239;0&#46;24 in the RLB group &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#46; The two groups had comparable operative times &#40;p&#8239;&#61;&#8239;0&#46;562&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The recorded MAP and HR readings showed no statistical differences between the two study groups&#46; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; During the first six hours after the surgical procedure&#44; the recorded pain scores showed no statistical difference between the two groups&#44; neither at rest nor during movement&#46; However&#44; the RLB had higher ranges compared to the PVB group&#46; The eight-hour reading and the subsequent ones showed significant elevation in the RLB group &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#41;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#44; we noticed a significant prolongation of the time to the first call for opioid analgesia in the PVB group &#40;median&#8239;&#61;&#8239;18 vs&#46; 12&#8239;h in the RLB group&#41;&#46; Additionally&#44; morphine consumption significantly decreased in the same group &#40;median&#8239;&#61;&#8239;3 vs&#46; 6&#8239;mg in the RLB group&#41;&#46; Although patient satisfaction did not differ statistically between our groups&#44; the PVB group had a higher percentage of satisfied subjects&#46; The incidence of GIT adverse events &#40;nausea and vomiting&#41; was statistically comparable between the two groups&#44; and no block-related complications&#40; pneumothorax&#44; hemothorax&#44; intrathecal spread&#44;&#8230;&#46;etc&#41; were encountered in our study&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">To our knowledge&#44; a significant advantage of current research is that this is the first study to assess the analgesic efficacy of RLB and PVB in individuals undergoing elective inguinal hernioplasty&#46; In our study&#44; we preferred to install either block technique before the skin incision&#44; as we strongly believe in &#34;preemptive analgesia&#46;&#34; Preemptive analgesia prevents the transmission of nociceptive impulses&#44; inhibiting both central and peripheral sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> That makes it more effective than block installation after the surgical trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Our findings revealed that PVB is an effective option for perioperative pain management in inguinal hernioplasty patients&#46; That was evident in the stable intraoperative hemodynamics&#44; low average postoperative VAS&#44; modest morphine requirements&#44; and excellent patient satisfaction with no incidence of opioid-related complications&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Multiple trials have confirmed the efficacy of PVB in providing and maintaining analgesia not only after hernial repair procedures but also after other abdominal surgeries like cholecystectomy&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> hepatectomy&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> gynecological&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and urological procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The analgesic action of PVB could be explained by the effect of the local anesthetic injectate in the paravertebral space&#44; along with its extension to the epidural and intercostal spaces&#46; Also&#44; systemic absorption of these local anesthetics may play a role&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Our research discovered that RLB&#39;s ability to provide postoperative analgesia was far behind PVB&#39;s&#46; This was reflected in the RLB group&#39;s shorter time to the initial opioid call&#44; more opioid use&#44; and greater pain levels&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The RLB was first described by Pfeiffer in 2006&#44; who did this block using the landmark technique without using ultrasound guidance&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> That block targets the vertebral laminas posterior surface and could be applied in cervical&#44; thoracic&#44; or lumbar regions&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The mechanism of analgesia provided by the RLB is quite similar to the PVB&#44; as the injectate spreads to the paravertebral&#44; intercostal&#44; and epidural spaces and the intervertebral foramina&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> Nonetheless&#44; the injectate spread is limited compared to the PVB&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> That could be explained by the facet joint capsule&#44; lamina&#44; and spinous process&#44; which act as anatomical barriers hindering the free spread of the injectate&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;20</span></a> That could explain the lower analgesic outcomes in our RLB group compared to the PVB one&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Wang and his associates confirmed the superiority of PVB against RLB in their lung cancer patients undergoing thoracoscopic surgery&#46; The measured postoperative VAS had significantly lower values in the PVB group at rest &#40;for the initial 48&#8239;h&#41; and during cough &#40;for the initial 36&#8239;h&#41; compared to the RLB group&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In mastectomy patients&#44; Murouchi and Yamakage compared the same two blocks &#40;but continuously rather than a single bolus injection&#41;&#46; Postoperative pain was compared using the amount of block PCA &#40;3&#8239;ml 0&#46;25&#37; levobupivacaine with 30-min lockout&#41;&#46; The frequency of block patient-controlled analgesia was higher in association with the RLB&#40;6 vs&#46; 2&#46;5 in the PVB group&#41;&#46; The remifentanil dose was higher in the RLB group &#40;0&#46;06 vs&#46; 0&#46;01&#8239;&#181;g&#47;kg&#47;min in the PVB group&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Furthermore&#44; Sugiyama et al&#46; found that postoperative VAS was higher in the RLB group compared to the PVB group in their patients undergoing thoracoscopic procedures when patients with longer incisions were excluded&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the same context&#44; Onishi et al&#46; reported that RLB provided Analgesia for only 2&#8211;3&#8239;hours after mastectomy procedures&#44; which is significantly shorter than the reported analgesic period provided by PVB&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">We noted only one advantage for the RLB&#44; which is the easy application&#44; which was reflected in the time to perform the block&#46; It was significantly shorter than the time needed for the PVB&#46; Multiple studies reported that that block took less time than the PVB&#46; Perhaps because of its prominent bonny landmark&#44; the injection location is more easily accessible&#44; and the block takes less time to complete&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;18</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Our findings showed a slight increase in the incidence of GIT adverse events in the RLB group without reaching a statistical significance level&#46; That could be secondary to the increased pain severity or increased opioid intake in the same group compared to the other&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">We did not encounter any block-related adverse events with the two block procedures&#46; That could be secondary to the performance of both blocks under ultrasound guidance&#44; which increases the accuracy of delivery of the injectate to the required plane without injury to the surrounding neurovascular structures&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The better perioperative analgesic profile and lower incidence of complications led to better patient satisfaction in the PVB group&#44; which was manifested by the rise in the percentage of patients reporting &#34;very satisfied&#34; or &#34;satisfied&#34; status&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limitations</span><p id="par0165" class="elsevierStylePara elsevierViewall">Our trial handled a unique research point&#46; However&#44; it has some drawbacks&#46; We included a relatively small patient sample collected from a single hospital&#46; Also&#44; we should have evaluated the effect of these blocks on the incidence of chronic postsurgical inguinal pain &#40;inguinodynia&#41;&#46; No comparison was made with other ultrasound-guided peripheral blocks&#59; it would be helpful if further studies involved these issues&#46; The age range selected for our institute&#39;s protocol is 20&#8211;60&#46; This is because those 18 years or under are considered part of the kid population and are directed to a children&#39;s hospital&#46; The higher incidence of inguinal hernia in males results in a more significant number of male patients&#46; We eliminated patients classified as ASA III due to the potential interference of severe medical conditions with the study&#39;s anesthesia protocol&#46; Additionally&#44; patients with poorly controlled diabetes may experience neuropathy&#44; which could introduce bias into the results&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">The PVB has a superior perioperative analgesic profile compared to the RLB&#44; which manifested in the prolonged duration to the first rescue analgesics&#44; better pain scores&#44; and less opioid consumption&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Author contributions</span><p id="par0175" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Study conception and design&#58; Aly E&#46; Rashad&#44; Mohammed Nashaat Mohammed&#44; Mona Gad&#44; Osama Bahy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Acquisition of data&#58; Aly E&#46; Rashad&#44; Mona Gad&#44; Zenat Eldadamony&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Analysis and interpretation of data&#58; Aly E&#46; Rashad&#44; Mohammed Nashaat Mohammed&#44; Mona Gad&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Critical revision of the manuscript&#58; Aly E&#46; Rashad&#44; Zenat Eldadamony&#44; Mona Gad&#44; Osama Bahy&#46;</p></li></ul></p><p id="par0200" class="elsevierStylePara elsevierViewall">The manuscript has been read and approved by all authors</p><p id="par0205" class="elsevierStylePara elsevierViewall">This manuscript has not been submitted for publication in any other journal&#46; It will not subsequently be submitted for potential publication in another journal until a decision has been made&#44; nor has it been published previously in any media&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Iranian clinical trial ID</span><p id="par0210" class="elsevierStylePara elsevierViewall">IRCT20220212054002N2 <a href="https://www.irct.ir/trial/68066">https&#58;&#47;&#47;www&#46;irct&#46;ir&#47;trial&#47;68066</a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financial disclosures</span><p id="par0220" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In daily surgical practice&#44; inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain&#46; Multiple regional blocks have been described for analgesia after such operations&#46; Retrolaminar block &#40;RLB&#41; is a paravertebral block &#40;PVB&#41; variant that provides excellent analgesia and reduces the risk of complications&#46; This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level&#58; PVB group &#40;28 patients&#41; and RLB &#40;28 patients&#41;&#46; Time until the first rescue analgesia was our primary outcome&#46; Other outcomes included the time to perform the block&#44; changes in intraoperative hemodynamic parameters&#44; postoperative VAS&#44; 24-h morphine consumption&#44; the level of patient satisfaction&#44; and the incidence of block-related complications&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Demographic data were comparable in the two groups&#46; However&#44; the time needed for the block was significantly shortened with the RLB &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Patients in the PVB groups expressed better pain scores and lower opioid consumption&#46; Additionally&#44; the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB&#46; There was no discernible difference in the frequency of adverse events and recorded MAP and HR&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The PVB has a superior perioperative analgesic profile compared to the RLB&#44; which manifested in the prolonged duration to the first rescue analgesics&#44; better pain scores&#44; and less opioid consumption&#44; with no significant increase in block-related complications&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La hernioplastia inguinal es un procedimiento quir&#250;rgico com&#250;n que est&#225; asociado frecuentemente a dolor postoperatorio severo&#46; En este context&#44; se han descrito muchos bloqueos regionales diferentes&#46; El bloque retrolaminar &#40;BRL&#41; es una variante del bloqueo paravertebral &#40;BPV&#41; que aporta analgesia excelente y reduce el riesgo de complicaciones&#46; Este estudio prospectivo compara la eficacia analg&#233;sica de BPV y BRL en la hernioplastia inguinal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se aleatoriz&#243; a los 56 pacientes incluidos en dos grupos&#58; el grupo BPV &#40;28 pacientes&#41; y el grupo BRL &#40;28 pacientes&#41;&#46; Todos los bloqueos nerviosos fueron realizados con gu&#237;a ecogr&#225;fica en T12&#46; La medida del resultado primario fue el tiempo hasta la primera solicitud de analgesia de rescate&#46; Los resultados secundarios incluyeron el tiempo necesario para realizar el bloqueo&#44; los cambios de los par&#225;metros hemodin&#225;micos intraoperatorios&#44; el dolor postoperatorio calificado con la escala visual anal&#243;gica &#40;EVA&#41;&#44; el consumo de morfina durante 24 horas&#44; la satisfacci&#243;n del paciente&#44; y la incidencia de complicaciones relacionadas con el bloqueo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Los datos demogr&#225;ficos fueron similares en ambos grupos&#46; El tiempo necesario para realizar el bloqueo fue significativamente menor en el grupo BRL &#40;p&#8239;&#60;&#8239;0&#44;001&#41;&#46; Los pacientes del grupo BPV tuvieron menores puntuaciones EVA&#44; menor consumo de opioides y un tiempo significativamente mayor hasta la solicitud de opioides de rescate&#46; No existi&#243; diferencia discernible en cuanto a la frecuencia de episodios adversos y cambios de la presi&#243;n arterial y frecuencia cardiaca&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Los pacientes que recibieron BPV perioperatorios reflejaron un tiempo m&#225;s prolongado hasta la primera solicitud de analgesia de rescate&#44; menores puntuaciones para el dolor&#44; menor consumo de opioides&#44; y ausencia de incremento significativo de complicaciones relacionadas con el bloqueo&#44; lo cual refleja que esta t&#233;cnica es superior a BRL en la hernioplastia inguinal&#46;</p></span>"
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">27 &#40;96&#46;43&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;3&#46;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">BMI &#40;kg&#47;m2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#46;64&#8239;&#177;&#8239;2&#46;4</td><td class="td" title="\n
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                  \t\t\t\t">27&#46;15&#8239;&#177;&#8239;2&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;1&#46;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;82&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">20 &#40;71&#46;43&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18 &#40;64&#46;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;567&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">8 &#40;28&#46;57&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;35&#46;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morphine consumption during 24&#8239;h &#40;mg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;2&#46;89&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Satisfied&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Highly unsatisfied&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Complications&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nausea and vomiting&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Block-related complications&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Analgesic profile in the postoperative period&#44; satisfaction&#44; and incidence of complications in the study groups&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
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              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International guidelines for groin hernia management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;P&#46; Simons"
                            1 => "M&#46; Smietanski"
                            2 => "H&#46;J&#46; Bonjer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10029-018-1733-0"
                      "Revista" => array:7 [
                        "tituloSerie" => "Hernia"
                        "fecha" => "2018"
                        "volumen" => "22"
                        "numero" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29453501"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                0 => array:2 [
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                      "titulo" => "Ilioinguinal&#47;iliohypogastric nerve block versus transversus abdominis plane block for pain management following inguinal hernia repair surgery&#58; a systematic review and meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2024.03.008

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