Faculty Collaboration Database

Paravertebral block associated with decreased opioid use and less nausea and vomiting after reduction mammaplasty. J Surg Res 2018 Aug;228:307-313

Date

06/17/2018

Pubmed ID

29907226

DOI

10.1016/j.jss.2018.03.018

Scopus ID

2-s2.0-85045385392 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: In light of data finding that postoperative pain, nausea, and vomiting worsen outcomes, a renewed emphasis has been placed on optimizing the perioperative period. Use of preoperative paravertebral block (PVB) has been shown to reduce opioid administration and postoperative nausea and vomiting (PONV) in many surgical populations, though its role in reduction mammaplasty remains undefined. Therefore, we seek to evaluate PVB as an adjunct to general anesthesia (GA) for reduction mammaplasty.

MATERIALS AND METHODS: We reviewed records for patients who underwent reduction mammaplasty at our institution from 2010 to 2015. Patients were categorized into two groups: GA alone and GA + PVB (GA with PVB adjunct). Demographic information, opioid administration, phase I/II pain scores, presence of PONV, and anesthesia time were analyzed. Analysis was performed using t-tests and Fisher's exact test, with P-values less than 0.05 statistically significant.

RESULTS: We identified 264 patients meeting criteria: 209 (79%) received GA alone and 55 (21%) received GA + PVB. Intraoperative opioid administration were lower for GA + PVB patients (morphine equivalent of 44 mg versus 35 mg, P = 0.019), though there was no difference in postoperative opioid administration (P = 0.915). Phase I and II pain scores were significantly lower for those receiving PVB (2.9 versus 3.9, P = 0.012, and 3.0 versus 4.2, P = 0.001, respectively). GA + PVB was associated with less PONV (14% versus 33%, P = 0.007) and longer anesthesia times (271 min versus 236 min; P = 0.001).

CONCLUSIONS: By improving pain control and reducing PONV, factors known to be associated with poor patient satisfaction and inferior outcomes, PVB is an attractive anesthetic adjunct in elective breast surgery.

Author List

Rivedal DD, Nayar HS, Israel JS, Leverson G, Schulz AJ, Chambers T, Afifi AM, Blake JM, Poore SO

Author

David Rivedal MD Assistant Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Analgesics, Opioid
Anesthesia, General
Anesthetics, Local
Breast
Cytoreduction Surgical Procedures
Elective Surgical Procedures
Female
Humans
Mammaplasty
Middle Aged
Nerve Block
Organ Size
Pain Management
Pain Measurement
Pain, Postoperative
Patient Satisfaction
Perioperative Care
Postoperative Nausea and Vomiting
Time Factors
Treatment Outcome