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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Non-Obese Patients (Group NO: body mass index (BMI) <30) | 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) | 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bilateral Thoracic paravertebral block | Procedure | The blocks were performed at the T3-T4 level bilaterally to block the dermatomes between the T2 and T6 levels (breast innervation area). |
| Measure | Description | Time Frame |
|---|---|---|
| Thoracic paravertebral block (TPVB) performance time | 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 | 0-20 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative numeric rating scale (NRS) pain scores | NRS pain scores (0: no pain, 10: worst pain imaginable) through postoperative first 24 hours | 0-24 hours |
| Ideal US image visualization time |
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Inclusion Criteria:
Exclusion Criteria:
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Patients (obese and non-obese) required reduction mammoplasty surgery and received general anesthesia with TPVB analgesia
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| Name | Affiliation | Role |
|---|---|---|
| Emine A Salviz, Assoc Prof | Study Principal Investigator | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24587923 | Result | Kilicaslan A, Topal A, Erol A, Borazan H, Bilge O, Otelcioglu S. Ultrasound-guided multiple peripheral nerve blocks in a superobese patient. Case Rep Anesthesiol. 2014;2014:896914. doi: 10.1155/2014/896914. Epub 2014 Jan 22. | |
| 16551933 | Result | Franco CD, Gloss FJ, Voronov G, Tyler SG, Stojiljkovic LS. Supraclavicular block in the obese population: an analysis of 2020 blocks. Anesth Analg. 2006 Apr;102(4):1252-4. doi: 10.1213/01.ane.0000198341.53062.a2. |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D009765 | Obesity |
| D010549 | Personal Satisfaction |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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Time period between the US probe placement at T3-T4 level and visualizing the ideal image to perform the block
| 0-5 minutes |
| Difficulty of needle tip visualization | Likert scale: 1-5 (1:very poor, 5:very good) | 0-20 minutes |
| Number of needle maneuvers to reach the paravertebral space | Number of needle maneuvers to reach the paravertebral space (PVS) | 0-20 minutes |
| Requirement of additional maneuver due to insufficient local anesthetic spread | Requirement of additional needle maneuver due to insufficient local anesthetic (LA) spread | 0-20 minutes |
| Difficulty of TPVB according to the anesthesiologists | Likert scale: 1-5 (1:very poor, 5:very good) | 0-20 minutes |
| Length of stay in postoanesthesia care unit (PACU) | Modified Aldrete Scoring system (≥9/10) | 0-1 hours |
| Number of patients required fentanyl intraoperatively | 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. | Intraoperative 2-6 hours |
| Time to postoperative first pain | Postoperative first pain description (NRS ≥4) until discharge | 0-48 hours |
| Number of paracetamol requirement through the postoperative first 24 hours | Paracetamol was used when postoperative pain NRS ≥4 in the postanesthesia care unit or on the wards (on postoperative day 1) | 0-24 hours |
| Number of tramadol requirement through the postoperative first 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) | 0-24 hours |
| Incidence of PONV through the postoperative first 24 hours | Number of feeling nausea or vomiting | 0-24 hours |
| Duration of sleep through the postoperative first 24 hours | Total hours of sleep at first night | 0-24 hours |
| Length of hospital stay | Post Anaesthetic Discharge Scoring System (PADSS) (≥9/10) | 0-48 hours |
| Patient satisfaction | Satisfaction score during hospital discharge: 0: very unsatisfied, 3: very satisfied | 0-48 hours |
| Surgeon satisfaction | Satisfaction score during hospital discharge: 0: very unsatisfied, 3: very satisfied | 0-48 hours |
| 28235511 | Result | Kula AO, Riess ML, Ellinas EH. Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients. J Clin Anesth. 2017 Feb;37:154-158. doi: 10.1016/j.jclinane.2016.11.010. Epub 2017 Jan 10. |
| 36763114 | Derived | Salviz EA, Bingul ES, Guzel M, Savran Karadeniz M, Turhan O, Emre Demirel E, Saka E. Comparison of Performance Characteristics and Efficacy of Bilateral Thoracic Paravertebral Blocks in Obese and Non-Obese Patients Undergoing Reduction Mammaplasty Surgery: A Historical Cohort Study. Aesthetic Plast Surg. 2023 Aug;47(4):1343-1352. doi: 10.1007/s00266-023-03270-w. Epub 2023 Feb 10. |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
| D001519 | Behavior |