Aesthetic Plastic Surgery

, Volume 31, Issue 6, pp 666–673

Day Case Breast Augmentation Under Paravertebral Blockade: A Prospective Study of 100 Consecutive Patients

  • Rodney Dean Cooter
  • G. E. Rudkin
  • S. E. Gardiner
Original Article

Abstract

Background

An increasing trend toward day surgery management requires plastic surgeons not only to be cognizant of block techniques, but also to assess their safety and efficacy objectively. Paravertebral block offers benefits by enhancing surgical anesthesia and postoperative analgesia. This study aimed to assess the safety and efficacy of paravertebral block for day patients undergoing submuscular breast augmentation. The primary outcome measure was the rate of block failure. The secondary outcome measures included recovery room stay, pain management, and block complications. On the basis of a literature review and audit results, the study objective also aimed to propose safe guidelines for ambulatory paravertebral block patients undergoing breast surgery.

Methods

A total of 100 patients undergoing 172 single-level paravertebral blocks (72 bilateral blocks) and sedation for submuscular breast augmentation were studied prospectively. A single-injection paravertebral block was performed at the T4 level using a loss of resistance technique. Surgical, anesthetic, and recovery room details were recorded. Analyses were performed to determine the association between recovery room times, body mass index, pain scores, and requirements for opioids, antiemetics, and vasopressors.

Results

The findings showed that 87% of the blocks were successful for surgical anesthesia and 94% of the blocks were successful for postoperative analgesia. The pain score for 74% of the subjects was 3 or less. Antiemetics were given for 10% of the patients with significantly longer recovery room times. Vasopressors were required for 6% of the patients. A surgically caused pneumothorax resulted in the only unplanned admission.

Conclusion

The study findings suggest that paravertebral block is a safe and effective technique for day case submuscular breast augmentation.

Keywords

Ambulatory surgical procedures Breast augmentation Nerve block Pain Paravertebral block 

References

  1. 1.
    Barrett J, Harmon D, Loughnane F, Finucane B, Shorten G: Paravertebral block. In: Barrett J, Harmon D, Loughnane F, Finucane B, Shorten G (eds) Peripheral nerve blocks and perioperative pain relief. Saunders: Edinburgh, pp. 135–138, 2004Google Scholar
  2. 2.
    Cotter JT, Nielsen KC, Guller U, et al. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery: An analysis of 9,342 blocks. Can J Anaesth 51:810–816, 2004PubMedGoogle Scholar
  3. 3.
    Coveney E, Weltz CR, Greengrass R, Iglehart JD, Leight GS, Steele SM, Lyerly HK: Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg 227:496–501, 1998CrossRefPubMedGoogle Scholar
  4. 4.
    Eason MJ, Wyatt R: Paravertebral thoracic block: A reappraisal. Anesthesia 34:638–642, 1979CrossRefGoogle Scholar
  5. 5.
    Greengrass R, Buckenmaier CC III: Paravertebral anesthesia/analgesia for ambulatory surgery. Best Pract Res Clin Anaesthesiol 16:271– 283, 2002CrossRefPubMedGoogle Scholar
  6. 6.
    Greengrass R, O’Brien F, Lyerly K, Hardman D, Gleason D, D’Ercole F, Steele S: Paravertebral block for breast cancer surgery. Can J Anesth 43:858–861, 1996PubMedGoogle Scholar
  7. 7.
    Greengrass R, Steele S: Paravertebral blocks for breast surgery. Tech Reg Anaesth Pain Manage 2:8–12, 1998CrossRefGoogle Scholar
  8. 8.
    Hammas B, Thörn S-E, Wattwii M: Superior prolonged antiemetic prophylaxis with a four -drug multimodal regimen: Comparison with propofol or placebo. Acta Anaesthesiol Scand 46:232–237, 2002CrossRefPubMedGoogle Scholar
  9. 9.
    Jaspers JJP, Posma AN, van Immerseel AAH, Gittenberger de Groot AC: The cutaneous innervation of the female breast and nipple–areola complex: Implications for surgery. Br J Plast Surg 50:249–259, 1997CrossRefGoogle Scholar
  10. 10.
    Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ: Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg 99:1837–1843, 2004CrossRefPubMedGoogle Scholar
  11. 11.
    Karmakar MK: Thoracic paravertebral block. Anesthesiology 95:771–780, 2001CrossRefPubMedGoogle Scholar
  12. 12.
    Karmakar MK, Ho AM-H, Law BK, Wong ASY, Shafer SL, Gin T: Arterial and venous pharmacokinetics of ropivacaine with and without epinephrine after thoracic paravertebral block. Anesthesiology 103:704–711, 2005CrossRefPubMedGoogle Scholar
  13. 13.
    Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA: Thoracic paravertebral block for breast surgery. Anesth Analg 90:1402–1405, 2000CrossRefPubMedGoogle Scholar
  14. 14.
    Lönnqvist PA, MacKenzie J, Soni AK, Conacher ID: Paravertebral blockade: Failure rate and complications. Anesthesia 50:813–815, 1995CrossRefGoogle Scholar
  15. 15.
    Macario A, Vitez TS, Dunn B, McDonald T: Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology 83:1138–1144, 1995CrossRefPubMedGoogle Scholar
  16. 16.
    Naja MZ, Ziade MF, Lönnqvist PA: Nerve-stimulator guided paravertebral blockade vs general anesthesia for breast surgery: A prospective randomized trial. Eur J Anaesthesiol 20:897–903, 2003CrossRefPubMedGoogle Scholar
  17. 17.
    Naja Z, Lönnquvist PA: Somatic paravertebral nerve blockade: Incidence of failed block and complications. Anesthesia 56:1184–1188, 2001CrossRefGoogle Scholar
  18. 18.
    Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass RA, Pietrobon R: Influence of obesity on surgical regional anesthesia in the ambulatory setting: An analysis of 9,038 blocks. Anesthesiology 102:181–187, 2005CrossRefPubMedGoogle Scholar
  19. 19.
    Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E: Single-injection paravertebral block compared to general anesthesia in breast surgery. Acta Anaesthesiol Scand 43:770–774, 1999CrossRefPubMedGoogle Scholar
  20. 20.
    Pusch F, Wildling E, Klimscha W, Weinstabl C: Sonographic measurement of needle insertion depth in paravertebral blocks in women. Br J Anaesth 85:841–843, 2000CrossRefPubMedGoogle Scholar
  21. 21.
    Richardson J, Lonnqvist PA: Thoracic paravertebral block. Br J Anaesth 81:230–238, 1998PubMedGoogle Scholar
  22. 22.
    Richardson J, Sabanathan S: Thoracic paravertebral analgesia. Acta Anaesthesiol Scand 39:1005–1015, 1995PubMedCrossRefGoogle Scholar
  23. 23.
    Sarhadi NS, Shaw Dunn J, Lee FD, Souter DS: An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plas Surg 49:156–164, 1996CrossRefGoogle Scholar
  24. 24.
    Terheggen MA, Wille F, Rinkes IHB, Ionescu TI, Knape JT: Paravertebral blockade for minor breast surgery. Anesth Analg 94:355–359, 2002CrossRefPubMedGoogle Scholar
  25. 25.
    Wallace MS, Wallace AM, Lee J, Dobke MK: Pain after breast surgery: A survey of 282 women. Pain 66:195–205, 1996CrossRefPubMedGoogle Scholar
  26. 26.
    Weltz CR, Greengrass RA, Lyerly HK: Ambulatory surgical management of breast carcinoma using paravertebral block. Ann Surg 222:19–26, 1995CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Rodney Dean Cooter
    • 1
  • G. E. Rudkin
    • 2
  • S. E. Gardiner
    • 3
  1. 1.Waverley House Plastic Surgery CentreAdelaideAustralia
  2. 2.Specialist Anaesthetic ServicesUnleyAustralia
  3. 3.School of MedicineFlinders UniversityAdelaideAustralia

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