Background

Fine et al and others have been exploring alternative methods of anesthesia for abdominoplasties to safely avoid general anesthesia. 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. We have added the use preoperative rib blocks with a bupivicaine/lidocaine mix to supplement traditional anesthesia techniques in abdominoplasties in an attempt to obtain these benefits.

Methods

All cases of abdominoplasty performed by the author 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. 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; use of intra and post-op anti-emetics; need for LMA; frequency of PONV and 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, PONV and pain were achieved using rib blocks. Operative times, intraoperative narcotic and antiemetic drugs as well as ASA, BMI, age, complications were all similar for both groups.

Conclusion

Rib blocks placed before the start of surgery result in decreased recovery room times, pain and PONV achieving increased patient comfort and feasibility of performing abdominoplasties in the outpatient setting.