Treatment of postoperative pain after laparoscopic cholecystectomy

Thoracic Paravertebral Block: Thoracic paravertebral block is the technique of injecting local anesthetic along side the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen. This produces unilateral, segmental, somatic, and sympathetic nerve blockade, which is effective for anesthesia and in treating acute and chronic pain of unilateral origin from the chest and abdomen. (https://www.nysora.com/regional-anesthesia-for-specific-surgical-procedures/abdomen/thoracic-lumbar-paravertebral-block/) After the most prominent C7, processus spinosum in the cervical region was determined by palpation with the patients in a sitting position with their head slightly tilted forward, the relevant area was cleaned, we marked caudally one by one under US guidance. And 2,5-3 cm lateral of the T8 spinous process was marked as the injection point. At the needle insertion site, 2 mL of 2% lidocaine was infiltrated into the subcutaneous tissue. After placing the linear US probe on the marked area for paravertebral block application in the longitudinal plane, consecutive transverse processes and the pleura, superior costotransverse ligament, and paravertebral area were determined. With the in-plane technique, an 80 mm 22 gauge peripheral block needle was directed caudally to the cephalad, and the needle tip was advanced into the thoracic paravertebral area until the superior costotransverse ligament was passed. After confirming there was no vascular interference with aspiration, 2-3 mL of 0,9% saline was administered and ventral movement of the parietal pleura was observed to confirm the needle location, and TPVB was administered by injecting 20 mL of 0.25% bupivacaine . All TPVBs were performed by an anesthesiologist who has been working for at least 5 years. The approximate time taken to perform the thoracic paravertebral block is 10 min and performed 10 minutes before commencing surgery. The suitability of the block was evaluated with the loss of cold sensation up and down two levels in the mid-clavicular line.