Bilateral Thoracic Paravertebral Blocks in Obese and Non-obese Patients Undergoing Reduction Mammaplasty
Bilateral Thoracic Paravertebral Blocks in Obese and Non-obese Patients Undergoing Reduction Mammaplasty
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.
Inclusion Criteria:

 -  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

 Exclusion Criteria:

 -  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