Journal of Anesthesia

, Volume 33, Issue 1, pp 50–57 | Cite as

Three versus five lumbar paravertebral injections for inguinal hernia repair in the elderly: a randomized double-blind clinical trial

  • Zoher NajaEmail author
  • Saleh Kanawati
  • Ziad El Khatib
  • Fouad Ziade
  • Rakan Nasreddine
  • Ahmad Salah Naja
Original Article



The objective of the study was to compare three nerve stimulator-guided paravertebral injections versus five injections for elderly patients undergoing inguinal hernia repair in terms of the amount of intraoperative fentanyl and propofol consumption and conversion to general anesthesia. The secondary objective was postoperative pain.


A prospective, randomized, double-blind clinical trial was performed. 200 elderly patients undergoing unilateral herniorrhaphy were randomized into two groups. Group III received three PVB injections from T12 to L2 and placebo at T11 and L3. Group V received five PVB injections from T11 to L3.


The mean intraoperative fentanyl and propofol consumption were significantly lower in group V (4.9 ± 7.2 µg versus 20.0 ± 12.9 µg and 5.7 ± 11.6 mg versus 34.6 ± 22.9 mg, respectively, p value < 0.0001). Five patients (5.0%) in group III had failed block and were converted to general anesthesia (p value = 0.024). Group V had significantly lower pain scores compared to group III during the first three postoperative days (p value < 0.0001).


The five PVB injection technique is more suitable as a sole anesthetic technique for elderly patients undergoing herniorrhaphy, since it required less intraoperative supplemental analgesia and provided lower postoperative pain scores compared to the three PVB injection technique.

Trial registration identifier: NCT02537860.


Nerve block Postoperative pain Geriatric anesthesia 


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Anesthesia and Pain Management DepartmentMakassed General HospitalBeirutLebanon
  2. 2.Surgery DepartmentMakassed General HospitalBeirutLebanon
  3. 3.Faculty of Public HealthLebanese UniversityBeirutLebanon
  4. 4.American University of Beirut Medical CenterBeirutLebanon

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