Ultrasound-Guided Thoracic Paravertebral Blocks in Patients Undergoing Reduction Mammoplasty
Condition: Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Observational

Summary: 
      Background: Thoracic paravertebral blocks (TPVBs) have been effective for postoperative
      analgesia in mastectomy, thoracic and video-assisted thoracic surgeries.

      Objective: To assess whether addition of ultrasound-guided TPVBs to general anaesthesia (GA)
      could postpone time to first pain and improve postoperative analgesia in patients undergoing
      bilateral reduction mammoplasty.

      Design: A historical cohort study. Patients: Of the 70 female patients who underwent
      bilateral reduction mammoplasty, 64 patients had complete data in the acute pain/regional
      anaesthesia database.

      Intervention: Thirty patients, received only GA, were included in Group GA. Thirty-four
      patients, received bilateral single injection ultrasound-guided TPVBs with 20 mL bupivacaine
      0.375% as an adjunct to GA, were included in Group TPVBs. Patients in both groups were
      administered intraoperative fentanyl if heart rate or mean arterial pressure increased >20%
      above pre-induction values, postoperative tramadol 1mg/kg in the postoperative care unit
      (PACU) if numeric rating scale (NRS) was ≥4, and rescue analgesics as metamizole sodium 4x1g
      and/or paracetamol 3x1g on wards (NRS≥4).

      Main outcome measures: The primary endpoint was time to first pain after the surgery.
      Secondary endpoints were intra- and postoperative opioid and other rescue analgesic
      requirements, length of stay in the PACU, pain scores, incidence of postoperative nausea and
      vomiting (PONV), and patient and surgeon satisfaction through the postoperative first 2 days.
    

Detailed description: 
      Background: Thoracic paravertebral blocks (TPVBs) have been effective for postoperative
      analgesia in mastectomy, thoracic and video-assisted thoracic surgeries.

      Objective: The objective was to assess whether addition of ultrasound-guided TPVBs to general
      anaesthesia (GA) could postpone time to first pain and improve postoperative analgesia in
      patients undergoing bilateral reduction mammoplasty.

      Design: A historical cohort study. Patients: Of the 70 female patients who underwent
      bilateral reduction mammaplasty, 64 patients had complete data in the acute pain/regional
      anaesthesia database.

      Intervention: Standard monitoring was applied before any anesthetic techniques were
      performed. All patients were given sedation in the form of midazolam 1-2 mg and fentanyl
      50-100 µg. Patients underwent bilateral reduction mammaplasty were distributed to two groups
      due to their data: 1) Patients received only general anaesthesia (GA) were included in Group
      GA, and 2) Patients received preoperative US-guided TPVBs as an adjunct to GA were included
      in Group TPVBs. Thirty patients were in Group GA. Thirty-four patients who were in Group
      TPVBs received bilateral single injection ultrasound-guided TPVBs with 20 mL bupivacaine
      0.375% (20 mL per injection) at the level of T3-4, as an adjunct to GA. Patients in both
      groups were administered intraoperative fentanyl if heart rate or mean arterial pressure
      increased >20% above pre-induction values. They also received postoperative tramadol 1mg/kg
      in the postoperative care unit (PACU) and rescue analgesics as metamizole sodium 4x1g and/or
      paracetamol 3x1g on wards, if numeric rating scale (NRS) was ≥4.

      Main outcome measures: The primary endpoint was time to first pain after the surgery.
      Secondary endpoints were intra- and postoperative opioid and other rescue analgesic
      requirements, length of stay in the PACU, pain scores, incidence of postoperative nausea and
      vomiting (PONV), and patient and surgeon satisfaction through the postoperative first 2 days.
    

Intervention name(s): Thoracic paravertebral blocks (TPVBs); IV metamizole sodium, paracetamol
Intervention type(s): Drug; Drug
Intervention description(s): Patients received bilateral single injection ultrasound-guided TPVBs with 20mL bupivacaine 0.375% at the level of T3-T4 as an adjunct to GA, intraoperative fentanyl and postoperative tramadol, metamizole sodium and paracetamol were used.; Patients received only standardized GA, intraoperative fentanyl and postoperative tramadol, metamizole sodium and paracetamol were used.
Other intervention name(s): Bupivacaine,fentanyl,tramadol,metamizole sodium,paracetamol; Fentanyl,tramadol,metamizole sodium,paracetamol
Intervention MeSH terms: Acetaminophen; Dipyrone; Fentanyl; Tramadol; Bupivacaine
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Female patients undergoing bilateral reduction mammoplasty
      
Keywords: Thoracic Paravertebral Blocks; Ultrasound Guidance; Reduction Mammoplasty; Time to First Pain; Postoperative Analgesia