Out-of-plane ultrasound-guided paravertebral blocks improve analgesic outcomes in patients undergoing video-assisted thoracoscopic surgery

Corey Amlong, Moltu Guy, Kristopher M Schroeder, Melanie J Donnelly Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, WI, USA Purpose: Paravertebral blocks (PVBs) are a method of limiting postoperative pain for patients undergoing video-assisted thoracoscopic surgery (VATS). We began providing ultrasound-guided PVBs for patients undergoing VATS in the spring of 2011, using an out-of-plane approach. The aim of this study was to evaluate this practice change. Methods: Following institutional review board approval, we reviewed the charts of 114 patients undergoing VATS by one surgeon at our institution between January 2011 and July 2012. Of the 78 eligible patients, 49 patients received a PVB prior to surgery. We evaluated opioids administered in the perioperative period, pain scores, and side effects from pain medications. Results: Patients who received a preoperative PVB required fewer narcotics intraoperatively and during their hospital stay (P=0.001 and 0.011, respectively). Pain scores on initial assessment and in recovery were lower in patients who received a PVB (P=0.005), as were dynamic and resting pain scores at 24 hours after surgery (P=0.003 and P<0.001, respectively). Patients receiving a PVB had fewer episodes of treated nausea both in the postanesthesia care unit (P=0.004) and for the first 24 hours after surgery (P=0.001). These patients also spent less time in recovery (P=0.025) than the patients who did not receive a block. Conclusion: The current study suggests improved outcomes in patients who underwent VATS with a preoperative PVB. All variables showed a trend toward improved results in patients who obtained a preoperative PVB. Keywords: nerve blocks, video-assisted thoracoscopic surgery, anesthesia, pai

Detecting an association between socioeconomic status and late stage breast cancer using spatial analysis and area-based measures

To assess the relationship between socioeconomic status (SES) and late stage breast cancer using the cluster detection software SaTScan and U.S. census-derived area-based socioeconomic measures. Florida's 18,683 women diagnosed with late stage breast cancer (regional or distant stage) between 1998 and 2002 as identified by Florida's population-based, statewide, incidence registry were analyzed by SaTScan to identify areas of higher-than-expected incidence. The relationship between SES and late stage breast cancer was assessed at the neighborhood (block group) level by combining the SaTScan results with area-based SES data. SaTScan identified 767 of Florida's 9,112 block groups that had higher-than-expected incidence of late stage breast cancer. After controlling for patient level insurance status, county level mammography prevalence, and urban/rural residence in the logistic regression model, women living in neighborhoods of severe and near poverty were respectively 3.0 and 1.6 times more likely to live in areas of higher-than-expected incidence of late stage breast cancer when compared with women living in nonpoverty. Additionally, areas in the lowest quartile of mammography usage were almost seven times more likely to have higher-than-expected incidence than areas in the higher quartiles. In addition to confirming the importance of mammography, results from the present study suggest that "where" you live plays an important role in defining the risk of presenting with late stage breast cancer. Additional research is urgently needed to understand this risk and to leverage the strengths and resources present in all communities to lower the late stage breast cancer burden