Bilateral Thoracic Paravertebral Blocks in Obese and Non-obese Patients Undergoing Reduction Mammaplasty
Condition: Pain, Postoperative; Obesity; Thoracic Paravertebral Blocks; Ultrasound; Performance
MeSH terms: Pain, Postoperative
Study type: Observational

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.
    

Intervention name(s): Bilateral Thoracic paravertebral block
Intervention type(s): Procedure
Intervention description(s): The blocks were performed at the T3-T4 level bilaterally to block the dermatomes between the T2 and T6 levels (breast innervation area).
Other intervention name(s): TPVBs
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients (obese and non-obese) required reduction mammoplasty surgery and received general
        anesthesia with TPVB analgesia
      
Keywords: Obesity; Thoracic paravertebral blocks; Ultrasound-guidance; Performance difficulty; Satisfaction