Bilateral Thoracic Paravertebral Blocks in Obese and Non-obese Patients Undergoing Reduction Mammaplasty
- Conditions
- ObesityPain, PostoperativePerformanceThoracic Paravertebral BlocksUltrasound
- Interventions
- Procedure: Bilateral Thoracic paravertebral block
- Registration Number
- NCT04596787
- Lead Sponsor
- Istanbul University
- Brief Summary
Aim: Although regional anesthesia (RA) 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. 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.
- Detailed Description
Aim: The number of obese patients (body mass index (BMI)≥30) has increased dramatically worldwide, and we, as anesthesiologists, routinely come up against them in our daily clinical practice. Although the preference of various peripheral and neuroaxial regional anesthesia (RA) techniques seems to be advantageous in the anesthetic management of these patients, their performances can also be associated with technical difficulties and greater failure rates. The aim of this study is to compare the performance properties and analgesic efficacy of ultrasound (US)-guided 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. Student's t, Mann-Whitney-U and Chi-square tests were used for statistical analysis.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 82
- American Society of Anesthesiologists (ASA) physical status of 1-3
- Capable of consenting
- Capable of understanding the instructions for using the NRS pain scores
- Capable of replying the questions
- Lack of contraindications to regional anesthesia (allergy to a LA, local infection, and coagulopathy) and especially TPVB
- Absence of mental/psychiatric disorders
- Absence of chronic analgesic/opioid use
- Absence of alcohol/illicit drug use
- Patient refusal of RA/TPVB performance
- American Society of Anesthesiologists (ASA) physical status of 4
- Not capable of consenting
- Not capable of understanding the instructions for using the NRS pain scores
- Not capable of replying the questions
- Contraindications to regional anesthesia (allergy to a LA, local infection, and coagulopathy) and especially TPVB
- Presence of mental/psychiatric disorders
- Presence of chronic analgesic/opioid use
- Presence of alcohol/illicit drug use
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Non-Obese Patients (Group NO: body mass index (BMI) <30) Bilateral Thoracic paravertebral block Patients received bilateral single injection ultrasound (US)-guided bilateral thoracic paravertebral block (TPVB) at the level of T3-T4 with 20 mL bupivacaine 0.375% per injection/side. Obese Patients (Group O: body mass index (BMI) ≥30) Bilateral Thoracic paravertebral block Patients received bilateral single injection ultrasound (US)-guided bilateral thoracic paravertebral block (TPVB) at the level of T3-T4 with 20 mL bupivacaine 0.375% per injection/side.
- Primary Outcome Measures
Name Time Method Thoracic paravertebral block (TPVB) performance time 0-20 minutes Time period between the US probe placement to the right side at T3-T4 level and the needle withdrawal from the left side T3-T4 level
- Secondary Outcome Measures
Name Time Method Postoperative numeric rating scale (NRS) pain scores 0-24 hours NRS pain scores (0: no pain, 10: worst pain imaginable) through postoperative first 24 hours
Difficulty of needle tip visualization 0-20 minutes Likert scale: 1-5 (1:very poor, 5:very good)
Requirement of additional maneuver due to insufficient local anesthetic spread 0-20 minutes Requirement of additional needle maneuver due to insufficient local anesthetic (LA) spread
Difficulty of TPVB according to the anesthesiologists 0-20 minutes Likert scale: 1-5 (1:very poor, 5:very good)
Time to postoperative first pain 0-48 hours Postoperative first pain description (NRS ≥4) until discharge
Number of patients required fentanyl intraoperatively Intraoperative 2-6 hours If a ≥ 20% increase above preinduction values in MAP or HR was observed during the perioperative period, additional fentanyl dose (1 μg/kg) was applied intravenously.
Number of paracetamol requirement through the postoperative first 24 hours 0-24 hours Paracetamol was used when postoperative pain NRS ≥4 in the postanesthesia care unit or on the wards (on postoperative day 1)
Incidence of PONV through the postoperative first 24 hours 0-24 hours Number of feeling nausea or vomiting
Duration of sleep through the postoperative first 24 hours 0-24 hours Total hours of sleep at first night
Ideal US image visualization time 0-5 minutes Time period between the US probe placement at T3-T4 level and visualizing the ideal image to perform the block
Number of needle maneuvers to reach the paravertebral space 0-20 minutes Number of needle maneuvers to reach the paravertebral space (PVS)
Number of tramadol requirement through the postoperative first 24 hours 0-24 hours Tramadol was used when postoperative pain NRS ≥4 again after 1 hour of paracetamol application in the postanesthesia care unit or on the wards (on postoperative day 1)
Patient satisfaction 0-48 hours Satisfaction score during hospital discharge: 0: very unsatisfied, 3: very satisfied
Length of stay in postoanesthesia care unit (PACU) 0-1 hours Modified Aldrete Scoring system (≥9/10)
Length of hospital stay 0-48 hours Post Anaesthetic Discharge Scoring System (PADSS) (≥9/10)
Surgeon satisfaction 0-48 hours Satisfaction score during hospital discharge: 0: very unsatisfied, 3: very satisfied