The Performance Properties and Efficacy of Ultrasound-Guided Bilateral Thoracic Paravertebral Blocks in Obese and Non-obese Patients Undergoing Reduction Mammaplasty: A Historical Cohort Study
Emine Aysu Şalvız, Emre Sertaç Bingül, Mehmet Güzel, Meltem Savran Karadeniz, Özlem Turhan, Ebru Emre, Esra Saka
Aim: Although regional anesthesia techniques are advantageous in the anesthetic management of obese patients (body mass index (BMI)≥30); their performances can still be associated with technical difficulties and greater failure rates (1-3). The aim of this study is to compare the performance properties and analgesic efficacy of ultrasound (US)-guided bilateral thoracic paravertebral blocks (TPVBs) in obese and non-obese patients.
Material methods: After obtaining ethics committee approval; data of 82 patients, who underwent elective bilateral reduction mammaplasty under general anesthesia with adjunctive TPVB analgesia between December of 2016 and February of 2020, were reviewed. Patients were allocated into two groups with respect to their BMI scores (Group NO: BMI<30 and Group O: BMI≥30). Demographics, TPVB ideal US image visualization and performance times, needle tip visualisation and TPVB performance difficulties, number of needle maneuvers, surgical, anesthetic and analgesic follow-up parameters, incidence of postoperative nausea vomiting (PONV), sleep duration, length of postanesthesia care unit (PACU) and hospital stay, patient and surgeon satisfaction scores were all investigated and compared.
Results: Seventy-nine patients’ data were complete (Figure 1). Ideal US image visualization and TPVB performance times were shorter, needle tip visualisation and TPVB peformances were better, number of needle maneuvers were fewer and length of PACU stay was shorter in Group NO (p≤0.05). Surgical and anesthetic characteristics were similar (p>0.05) (Table 1). Postoperative NRS pain scores did not differ between groups except 12th hour (p>0.05) (Table 2). Time to postoperative first pain, total analgesic requirements, incidence of PONV, duration of sleep, length of hospital stay were all comparable (p>0.05). The patients and the surgeons were more satisfied in Group NO (p=0.048 and p=0.016) (Table 3).
Conclusion: Despite the improvement in US technology and experience in regional anesthesia, obesity can still be associated with TPVB performance difficulties effecting both patients’ and surgeons’ overall satisfaction.
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