Regional Anesthetic Blocks in Plastic Surgery Using Portable Ultrasound

Abstract

Background With the introduction of latest generation ultrasound technology and its easy availability and portability, regional anesthetic blocks, which were formally in the domain of anesthesiologists, have now become available to practicing plastic surgeons. Enhanced Recovery After Surgery protocols for other specialties such as orthopedics and colorectal surgery have incorporated regional anesthetic blocks. These regional blocks have been shown to be effective in improving the patient comfort and experience and decreasing reliance on opioid medications. Methods Patients scheduled for elective plastic surgery received PEC-1, serratus anterior plane, or transversus abdominis plane blocks as indicated for the proposed procedure. All blocks were performed under ultrasound guidance using the Philips Lumify system with the linear array 12-4 probe by the operating surgeon. Results A total of 83 patients received regional anesthetic blocks by the senior author. Thirty-three patients undergoing cosmetic breast augmentation or implant-based breast reconstruction received the PEC-1 and the serratus anterior plane blocks after the induction of anesthesia but before the prep and drape. Fifty patients undergoing either abdominoplasty or deep inferior epigastric perforator flap reconstruction received intraoperative transversus abdominis plane blocks. Anatomic planes were clearly visualized with this new ultrasound technology. Patients experienced good to excellent analgesia with less reliance on opioid medications and decreased need for refills. For hospitalized patients, length of stay in some cases was decreased up to 1 day, and PCA pumps were eliminated. There were no complications or adverse sequelae observed in any of these patients related to the regional blocks. Conclusions Incorporation of these known regional anesthetic techniques in this single-surgeon experience seems to confirm reports of effectiveness in the anesthesia literature and may be of benefit to a wide range of plastic surgery patients.

Ultrasound-Guided Transversus Abdominis Plane Blocks Versus Local Infiltration Anesthesia on Postanesthesia Care Unit Pain Control in Patients Undergoing Abdominoplasty

“…This is not surprising, as the propagation of the anesthetic bolus in the TAP plane would sometimes not cover the entire abdominal wall while being visualized with ultrasound. The 4-quadrant approach (subcostal and iliohypogastric injections) ensures that the TAP plane bolus extends all the way to the costal margin above and to the iliac crest below to cover dermatomes T7–L1 16,18 …”

“…Our method of 4-quadrant TAP blocks was published in this Journal and includes bilateral subcostal approaches to cover dermatomes T6-T10 and bilateral iliohypogastric approaches to cover T10-L1. 16,18 For these injections, a dilute solution of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, www.pacira.com) was used (20 cc Exparel + 50 cc 0.25% bupivacaine + 30 cc intravenous normal saline + 0.5 cc 1:1000 epinephrine). Twenty milliliters was used at each of the 4 injection sites, and the remaining 20 cc was infiltrated into the lower half of the abdominoplasty incision at the end of the case.…”

“…Barriers to providing the benefits of regional anesthetic blocks to these patients include expense, lack of anesthesiologists and plastic surgeons trained in regional blocks, and lack of availability of ultrasound in some outpatient surgery facilities. With improved technology, availability of low-cost, high-resolution, tablet-based ultrasound 13 and readily available training in regional anesthetic techniques, 14,15 many of the barriers have been overcome, and these advances may be of benefit to abdominoplasty patients 16,17 …”

“…With improved technology, availability of low-cost, high-resolution, tablet-based ultrasound 13 and readily available training in regional anesthetic techniques, 14,15 many of the barriers have been overcome, and these advances may be of benefit to abdominoplasty patients. 16,17…”

Single Injection Nerve Blocks Plus IV Lidocaine Infusions as an Alternative to Continuous Nerve Blocks for Perioperative Pain Management: A retrospective review

“…A number of authors have confirmed the safety of the postoperative infusion of lidocaine in doses ranging from 3,200mg to 6,000mg over a 48 hour period. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In the past few years, the use of interfacial plane blocks has been more and more advocated, 20 including erector spinae plane blocks (ESPB) for thoracic surgery, [21][22][23][24][25] pectoralis and serratus blocks for breast surgery [26][27][28][29] and quadratus lumborum (QL) blocks for abdominal surgery, 30 Intravenous lidocaine (IV lido) infusions have been demonstrated to be an effective technique for postoperative analgesia in several different types of surgery, including abdominal, [31][32][33][34] thoracic, 35,36 and spine. 37,38 We hypothesized that SNBs followed by IV lido would be as effective as CNBs.…”