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Outpatient Abdominoplasty Facilitated by Rib Blocks

Michaels, Basil M. M.D.; Eko, Frederick N. M.D.

Plastic and Reconstructive Surgery: August 2009 - Volume 124 - Issue 2 - p 635-642
doi: 10.1097/PRS.0b013e3181addbd7
Cosmetic: Original Articles

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.

Conclusion: 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.

Pittsfield, Mass.

From the Berkshire Cosmetic and Reconstructive Surgery Center and the Berkshire Medical Center.

Received for publication September 6, 2008; accepted February 20, 2009.

Poster presented at the Annual Meeting of the American Society of Plastic Surgeons, in Baltimore, Maryland, October 26 through 31, 2007.

Disclosure: Neither of the authors has any financial interests to disclose.

Basil M. Michaels, M.D., 426 South Street, Pittsfield, Mass. 01201,

©2009American Society of Plastic Surgeons