General anaesthesia combined with bilateral paravertebral blockade (T11-T12-L1) vs general anaesthesia for bilateral varicocelectomy. A randomized double-blind clinical trial.

Introduction: Varicocelectomy is a common operation in urology associated with considerable postoperative pain. The aim of this prospective, randomized, double-blind study was to investigate whether a combination of general anesthesia and bilateral nerve stimulator guided paravertebral nerve blocks could provide better postoperative pain relief compared to general anesthesia in combination with placebo paravertebral nerve block.

Methods: Sixty patients scheduled for varicocelectomy were randomized prospectively. Thirty patients each in either the active group (general anaesthesia combined with nerve stimulator guided bilateral paravertebral block) or the control group (general anaesthesia combined with normal saline nerve stimulator guided bilateral paravertebral block). Postoperative pain was assessed by visual analogue scale scores at predetermined time intervals.

Results: The active group was found to have better postoperative pain-relief (p < 0.005), reduced need for analgesics (p < 0.05), and also a more rapid return to normal activities (p < 0.001) compared to control group. Higher surgeon and patient satisfaction (p < 0.001) were noted in the active group compared to the control group.

Conclusion: Preoperative paravertebral blockade combined with general anesthesia showed significantly reduced postoperative pain scores and analgesic consumption, earlier return to normal activity and was associated with better patient and surgeon satisfaction during varicocelectomy surgery.