Block of the Lateral Branches of the Intercostal Nerve in the Midaxillary Line (BRILMA) for Costal Cartilage Harvest in Plastic Surgery Procedures

Abstract

Background and Aim: Autologous costal cartilage harvest is common in reconstructive surgeries and extremely painful for breathing and coughing. Block of the lateral branches of the intercostal nerve in the midaxillary line (BRILMA) can provide site-specific effective regional analgesia. Methodology: It was an observational study conducted after ethics committee approval on adult patients requiring costal cartilage grafts. BRLIMA was performed at the 6th rib in the midaxillary line under ultrasound guidance. We monitored hemodynamics, Visual Analog Scale (VAS) at rest and on deep breathing and coughing up to 24 h, analgesic requirement, and complications. Statistical analysis was done using Epi Info version 7.2. Results: During the 15-month study period, 34 patients received BRILMA and had a mean (standard deviation [SD]) age of 24.26 ± 4.81 years. The mean (SD) time required to perform the block was 5 ± 1.50 min. BRILMA efficacy was observed in 32 (94.1%) patients, while 2 (5.9%) patients required additional dexmedetomidine infusion intraoperatively and rescue analgesia postoperatively. The mean (SD) postoperative VAS score was 3.82. At 12 h, 23 (67.64%) patients had VAS ≤3 with no pain at rest and on deep breathing and coughing. In 13 (38.23%) patients, optimum analgesia extended up to 24 h postoperatively. There were no complications. Conclusion: BRILMA is an effective, safe, and site-specific regional anesthesia block for costal cartilage harvest surgery. It is a simple, quick, single puncture, and reproducible technique. BRILMA provided adequate intraoperative and postoperative analgesia with efficacy of 94.1% for costal cartilage harvest without any complications. Optimum postoperative analgesia at rest and on deep breathing and coughing was observed for up to 24 h, contributing to enhanced recovery.