Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients.
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.


CONCLUSIONS
The study findings suggest that paravertebral block is a safe and effective technique for day case submuscular breast augmentation.
Cooter
Rodney Dean
RD
Waverley House Plastic Surgery Centre, Level 1, Waverley House, 360 South Terrace, Adelaide, SA 5000, Australia. rdcooter@plasticsurgeryadelaide.com
Rudkin
G E
GE
Gardiner
S E
SE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D015992:Body Mass Index; D019928:Breast Implantation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011446:Prospective Studies; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D016387:Women's Health
D000779:Anesthetics, Local