Abdominoplasty study - Confex



Outpatient Abdominoplasty Facilitated by Rib Blocks

Basil M. Michaels, MD, Frederick N. Eko, MD and George A. Csank, MD

INTRODUCTION: Abramson and others have been exploring alternative methods of anesthesia for abdominoplasties to safely avoid general anesthesia.1-4 Preoperative methods to control pain may result in decreased narcotic administration, decreased Post Operative Nausea and Vomiting (PONV), and ultimately better pain control which all lead to increased patient comfort and feasibility of performing abdominoplasties as outpatient procedures. The preoperative use of rib blocks has been described for breast augmentation.5 We have added the use of preoperative rib blocks with a bupivicaine/lidocaine mix to supplement traditional anesthesia techniques in abdominoplasties in an attempt to obtain these benefits.

METHOD: All cases of abdominoplasty performed by the senior author (BMM) were reviewed from 1999 to 2006 and divided into two groups. Group 1 was comprised of the 39 surgeries performed using general endotracheal anesthesia (GETA). Group 2 was comprised of the 29 surgeries performed using rib blocks placed by the surgeon and supplemented by intravenous anesthesia with additional airway control by Laryngeal Mask (LMA) as needed. The rib blocks were placed bilaterally by the surgeon in the operating room prior to the start of surgery from ribs 4 to 12 using a mixture of 1 cc each of 0.25% bupivicaine and 1% lidocaine with 1 to 100,000 of epinephrine per block. The rib block group then had additional intravenous or inhalational anesthesia as necessary depending on patient comfort and additional procedures. The group that did not have rib blocks had standard general anesthesia. The abdominoplasties were performed in a manner similar to Lockwood’s technique with a limited lateral dissection and fascial imbrication from pubis to xiphoid.6

Thirteen patients were excluded from the present study because a pain pump was placed intraoperatively to help decrease post operative pain at home. Chart review collected data on: time in the operating room, and recovery room; use of intraoperative and post operative narcotics (measured as morphine equivalents); use of intra and post-op anti-emetics (measured as number of medications given); need for LMA; frequency of PONV and pain. Pain was assessed on a 1 to 10 patient reported scale with 1 as least and 10 as most pain. ASA class, BMI, additional concurrent procedures, and age were also compared to show the groups were similar. All anesthetic and surgical complications and the need for hospitalization were also recorded. Statistical analysis with student t-tests was used to reject the null hypothesis when comparing the two groups.

RESULTS: Statistically significant decreases in recovery room time, postoperative narcotics, PONV and pain were achieved using rib blocks. Operative times, and intraoperative narcotics and antiemetic drugs as well as ASA, BMI, and age, were all similar for both groups. Eight (28%) of patients in the rib block group had a LMA placed for inhalational anesthesia and this usually correlated with concomitant procedures performed such as breast augmentation. There were no hospitalizations, pneumothoraxes, major complications or deaths.

Times and Symptoms

| |OR time (min) |RR Time (min) |PONV in RR |Pain in RR |

|Rib Blocks (n=29) |231 |116 |4 (14%) |2 out of 10 |

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