Outpatient abdominoplasty facilitated by rib blocks.
BACKGROUND
Striving to increase patient comfort and feasibility of performing abdominoplasties as outpatient procedures, investigators have been exploring alternative methods of anesthesia to safely avoid general anesthesia. These techniques may result in decreased narcotic administration, and decreased postoperative nausea and vomiting. The authors have added the use of preoperative local anesthesia rib blocks with sedation to replace general anesthesia in abdominoplasties.


METHODS
All cases of abdominoplasty performed by the senior author (B.M.M.) were reviewed from 1999 to 2006 and divided into two groups. Group 1 was composed of 39 operations performed using general anesthesia. Group 2 was composed of 29 operations performed using rib blocks placed by the surgeon and supplemented by intravenous sedation. Chart review collected data on time in the operating and recovery rooms, use of narcotics and antiemetics, frequency of postoperative nausea and vomiting, and patient-reported pain. Possible confounding factors, additional procedures, anesthetic and surgical complications, and the need for hospitalization were also recorded. Statistical analysis with two-tailed Mann-Whitney and chi-square testing was used to reject the null hypothesis when comparing the two groups.


RESULTS
Statistically significant decreases in recovery room time, postoperative narcotics, postoperative nausea and vomiting, and pain were achieved using rib blocks. All other measures were similar for both groups. There were no hospitalizations, pneumothoraxes, major complications or deaths.


CONCLUSIONS
Rib blocks placed before the start of surgery result in decreased recovery room times, pain, and postoperative nausea and vomiting, achieving increased patient comfort and feasibility of performing abdominoplasties in the outpatient setting.
Michaels
Basil M
BM
Pittsfield, Mass. From the Berkshire Cosmetic and Reconstructive Surgery Center and the Berkshire Medical Center.
Eko
Frederick N
FN
D000005:Abdomen / Q000601:surgery; D000273:Adipose Tissue / Q000601:surgery; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General; D015992:Body Mass Index; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D012272:Ribs