To compare the effectiveness of an intercostal nerve block after costal cartilage harvest when a multimodal cocktail or ropivacaine plus patient-controlled analgesia is used, as measured by visual analog scale (VAS) scores, rescue analgesic consumption, and related complications.
Materials and Methods:
Eligible patients who underwent costal cartilage harvest were equally randomized to receive a multimodal cocktail (multimodal group) or ropivacaine plus patient-controlled analgesia (ropivacaine group).
Results:
Of 112 patients assessed, 12 (10.7%) patients were excluded and 100 (89.3%) patients were enrolled and assigned to multimodal group (n = 50) and ropivacaine group (n = 50). The VAS scores in the multimodal group were significantly lower than those in the ropivacaine group both at rest (0.924 ± 0.073 vs. 1.920 ± 0.073, p < 0.001) and during coughing (2.340 ± 0.083 vs. 3.944 ± 0.083, p < 0.001) in mixed-effects model analysis. Rescue analgesic consumption and rate of complications were significantly lower in the multimodal group compared with the ropivacaine group (all p < 0.05).
Conclusions:
Multimodal cocktail improved chest pain after costal cartilage harvest with less rescue analgesic consumption and complications compared with ropivacaine plus patient-controlled analgesia.
Clinical Trial Registration:
ChiCTR2100042445.
Get full access to this article
View all access options for this article.
References
1.
UppalRS, SabbaghW, ChanaJ, GaultDT. Donor-site morbidity after autologous costal cartilage harvest in ear reconstruction and approaches to reducing donor-site contour deformity. Plast Reconstr Surg. 2008; 121(6):1949–1955.
2.
SinghN, SidawyAN, DezeeK, et al.The effects of the type of anesthesia on outcomes of lower extremity infrainguinal bypass. J Vasc Surg. 2006; 44(5):964–968; discussion 968–970.
3.
NiiyamaY, YotsuyanagiT, YamakageM. Continuous wound infiltration with 0.2% ropivacaine versus a single intercostal nerve block with 0.75% ropivacaine for postoperative pain management after reconstructive surgery for microtia. J Plast Reconstr Aesthet Surg. 2016; 69(10):1445–1449.
4.
ChenN, QiaoQ, ChenR, XuQ, ZhangY, TianY. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial. J Clin Anesth. 2020; 59:106–111.
5.
KaushalB, ChauhanS, SainiK, et al.Comparison of the efficacy of ultrasound-guided serratus anterior plane block, pectoral nerves II block, and intercostal nerve block for the management of postoperative thoracotomy pain after pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2019; 33(2):418–425.
6.
KangCM, KimWJ, YoonSH, ChoCB, ShimJS. Postoperative pain control by intercostal nerve block after augmentation mammoplasty. Aesthetic Plast Surg. 2017; 41(5):1031–1036.
7.
MeouchyMG, AwaidaCJ, JabbourHJ, RayessYA, JabbourSF, NasrMW. Ultrasound-guided quadratus lumborum block for postoperative pain in abdominoplasty: a randomized controlled study. Plast Reconstr Surg. 2021; 147(4):851–859.
8.
HivelinM, WynieckiA, PlaudB, MartyJ, LantieriL. Ultrasound-guided bilateral transversus abdominis plane block for postoperative analgesia after breast reconstruction by DIEP flap. Plast Reconstr Surg. 2011; 128(1):44–55.
9.
LiuSS, RichmanJM, ThirlbyRC, WuCL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006; 203(6):914–932.
10.
AnantanarayananP, RajaDK, KumarJN, et al.Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine. J Oral Maxillofac Surg. 2013; 71(1):29–34.
11.
WooKJ, KangBY, MinJJ, ParkJW, KimA, OhKS. Postoperative pain control by preventive intercostal nerve block under direct vision followed by catheter-based infusion of local analgesics in rib cartilage harvest for auricular reconstruction in children with microtia: a randomized controlled trial. J Plast Reconstr Aesthet Surg. 2016; 69(9):1203–1210.
12.
WallPD. The prevention of postoperative pain. Pain. 1988; 33(3):289–290.
13.
LamplotJD, WagnerER, ManningDW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014; 29(2):329–334.
14.
KurosakaK, TsukadaS, SeinoD, MorookaT, NakayamaH, YoshiyaS. Local infiltration analgesia versus continuous femoral nerve block in pain relief after total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2016; 31(4):913–917.
15.
TsukadaS, WakuiM, HoshinoA. Postoperative epidural analgesia compared with intraoperative periarticular injection for pain control following total knee arthroplasty under spinal anesthesia: a randomized controlled trial. J Bone Joint Surg Am. 2014; 96(17):1433–1438.
16.
BuschCA, ShoreBJ, BhandariR, et al.Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am., 2006; 88(5):959–963.
17.
BuschCA, WhitehouseMR, ShoreBJ, MacDonaldSJ, McCaldenRW, BourneRB. The efficacy of periarticular multimodal drug infiltration in total hip arthroplasty. Clin Orthop Relat Res. 2010; 468(8):2152–2159.
18.
KehletH, DahlJB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993; 77(5):1048–1056.
19.
TianL, YouJ, WangH, et al.Comparison of two different grafts in nasal framework reconstruction of binder syndrome: cartilage and silicone. J Craniofac Surg. 2017; 28(6):1413–1417.
20.
TsukadaS, WakuiM, HoshinoA. The impact of including corticosteroid in a periarticular injection for pain control after total knee arthroplasty: a double-blind randomised controlled trial. Bone Joint J. 2016; 98-B(2):194–200.
21.
RossJA, GreenwoodAC, SasserP, 3rd, JiranekWA. Periarticular injections in knee and hip arthroplasty: where and what to inject. J Arthroplasty. 2017; 32(9S):S77–S80.
22.
KurosakaK, TsukadaS, OgawaH, et al.Addition of corticosteroid to periarticular injections reduces postoperative pain following total hip arthroplasty under general anaesthesia: a double-blind randomized controlled trial. Bone Joint J. 2020; 102-B(10):1297–1302.
23.
ChanVWK, ChanPK, YanCH, HenryCH, ChanCW, ChiuKY. Effect of steroid in local infiltration analgesia in one-stage bilateral total knee arthroplasty: a paired-randomized controlled study. J Knee Surg. 2020 [Epub ahead of print]; DOI: 10.1055/s-0040-1713811.
24.
El-BoghdadlyK, ShortAJ, GandhiR, ChanV. Addition of dexamethasone to local infiltration analgesia in elective total knee arthroplasty: double-blind, randomized control trial. Reg Anesth Pain Med. 2021; 46(2):130–136.
25.
WangQ, TanG, MohammedA, et al.Adding corticosteroids to periarticular infiltration analgesia improves the short-term analgesic effects after total knee arthroplasty: a prospective, double-blind, randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2021; 29(3):867–875.
26.
SheetsNW, DavisJW, DirksRC, et al.Intercostal nerve block with liposomal bupivacaine vs epidural analgesia for the treatment of traumatic rib fracture. J Am Coll Surg. 2020; 231(1):150–154.
27.
HwangEG, LeeY. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 2014; 10(4):241–244.
28.
ConchaM, DagninoJ, CariagaM, AguileraJ, AparicioR, GuerreroM. Analgesia after thoracotomy: epidural fentanyl/bupivacaine compared with intercostal nerve block plus intravenous morphine. J Cardiothorac Vasc Anesth. 2004; 18(3):322–326.
29.
MeierhenrichR, HockD, KuhnS, et al.Analgesia and pulmonary function after lung surgery: is a single intercostal nerve block plus patient-controlled intravenous morphine as effective as patient-controlled epidural anaesthesia? A randomized non-inferiority clinical trial. Br J Anaesth. 2011; 106(4):580–589.
30.
ChristensenCP, JacobsCA, JenningsHR. Effect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial. J Bone Joint Surg Am., 2009; 91(11):2550–2555.
31.
LiZ, LiZ, ChengK, WengX. The efficacy and safety of glucocorticoid on periarticular infiltration analgesia in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2021; 36(9):3340–3350.
32.
McMurrayRW, HardyKJ. Cox-2 inhibitors: today and tomorrow. Am J Med Sci. 2002; 323(4):181–189.
33.
HussainN, BrullR, SheehyBT, KushelevM, EssandohMK, AbdallahFW. The mornings after-periarticular liposomal bupivacaine infiltration does not improve analgesic outcomes beyond 24 hours following total knee arthroplasty: a systematic review and meta-analysis. Reg Anesth Pain Med. 2021; 46(1):61–72.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
