Comparison of perioperative and postoperative effects of single and double injection thoracic paravertebral block performances in patients undergoing bilateral macromastia (breast reduction) surgery

Comparison of perioperative and postoperative effects of single and double injection thoracic paravertebral block performances in patients undergoing bilateral macromastia (breast reduction) surgery Objective: The aim of this research is to compare the sensorial and analgesic effects of single and double techniques in patients undergoing macromastia surgery. Materials and Methods: After institutional ethics committee approval and informed consents; 60 patients aging between 18-70 years, with ASA 1-3 physical status and scheduled for elective bilateral macromastia surgery were enrolled to the study. Patients were randomized to single (Group 1: T3-T4) or double injection (Group 2: T2-T3 and T4-T5) TPVB groups. Patients were followed for their T2-T6 dermatomal block spread through 30 minutes, and then their surgeries were completed under general anesthesia. Besides the follow-up of dermatomal block spread and numeric rating scale (NRS) scores through postoperative first 48 hours; time to first pain, total opioid and other analgesic consumption administered during perioperative and postoperative periods were also noted. Primary outcome was NRS scores. Secondary outcomes were TPVB dermatomal block spread, time-to-first-pain and total analgesic consumption. Results: Fifty-two of 60 patients completed the study (Group 1: 28 and Group 2: 24). There was no difference between preoperative and postoperative numbers of blocked dermatomes, and postoperative NRS scores (p>0.05). Five patients in Group 1 and 4 in Group 2 did not complain of pain during the postoperative first 48 hours. In terms of time-to-first pain, there was no difference between the rest of the patients (p=0.214). Total consumed opioid and analgesic amounts were similar (p>0.05). Conclusion: Ultrasound-guided single and double injection TPVB techniques provided similar dermatomal sufficiency and analgesic effectiveness for patients undergoing elective macromastia surgeries. Key words: Paravertebral block, thoracic; Numeric pain scores; Block duration; Time-to-first pain; Analgesic consumption.