Postoperative Pain Control by Intercostal Nerve Block After Augmentation Mammoplasty

Kang, Chang Min; Kim, Woo Jeong; Yoon, Sean Hyuck; Cho, Chul Bum; Shim, Jeong Su

doi:10.1007/s00266-017-0802-6

Cited by 26 publications

(20 citation statements)

References 19 publications

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“…Treatment of post-thoracotomy pain includes the use of intravenous (IV) opioids, which have limitations due to side effects of sedation and respiratory depression [ 7 , 8 ]. Intercostal nerve blocks using local anesthetics are effective, but limited by their short duration of action and potential neurotoxicity in high volume [ 9 , 10 ]. Epidural analgesia is commonly used for post-thoracotomy without CPB [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The Prospective Randomized FROST Trial

et al. 2021

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Introduction: Intercostal cryo nerve block has been shown to enhance pulmonary function recovery and pain management in post-thoracotomy procedures. However, its benefit have never been demonstrated in minimal invasive thoracotomy heart valve surgery (Mini-HVS). The purpose of the study was to determine whether intraoperative intercostal cryo nerve block in conjunction with standard of care (collectively referred to hereafter as CryoNB) provided superior analgesic efficacy in patients undergoing Mini-HVS compared to standard-of-care (SOC). Methods: FROST was a prospective, 3:1 randomized (CryoNB vs. SOC), multicenter trial in patients undergoing Mini-HVS. The primary endpoint was the 48-h postoperative forced expiratory volume in 1 s (FEV1) result. Secondary endpoints were visual analog scale (VAS) scores for pain at the surgical site and general pain, intensive care unit and hospital length-ofstay, total opioid consumption, and allodynia at 6 months postoperatively. Results: A total of 84 patients were randomized to the two arms of the trial CryoNB (n = 65) and SOC (n = 19). Baseline Society of Thoracic Surgeons Predictive Risk of Mortality (STS PROM) score, ejection fraction, and FEV1 were similar between cohorts. A higher 48-h postoperative FEV1 result was demonstrated in the CryoNB cohort versus the SOC cohort (1.20 ± 0.46 vs. 0.93 ± 0.43 L; P = 0.02, one-sided two-sample t test). Surgical site VAS scores were similar between the CryoNB and SOC cohorts at all postoperative timepoints evaluated, but VAS scores not related to the surgical site were lower in the SOC group at 72, 94, and 120 h postoperatively. The SOC cohort had a 13% higher opioid consumption than the CryoNB cohort. One of 64 CryoNB patients reported allodynia that did not require pain medication at 10 months. Conclusions: The results of FROST demonstrated that intercostal CryoNB provided enhanced FEV1 score at 48 h postoperatively

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Section: Introductionmentioning

confidence: 99%

Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The Prospective Randomized FROST Trial

et al. 2021

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“…Studies on the efficacy of intercostal nerve block in postoperative analgesia particularly in patients undergoing thoracotomy and mammoplasty showed that this technique was as effective as other methods in the early period. [26][27][28] Intercostal nerve block has been further reported to reduce the incidence of chronic pain after thoracotomy. [29] Despite being a simple technique, it has not gained popularity in clinical practice particularly in patients who will undergo multiple dermatome blocks since it requires several repeated injections that increase the risk of pneumothorax and local anaesthetic toxicity.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of Erector Spinae Plane Block and Intercostal Nerve Block in the Postherpetic Neuralgia

Hacıbeyoğlu

Arıcan

Ulukaya

et al. 2020

Agri

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The aim of this study was to compare the efficacy of an intercostal nerve block, which has been used for many years in the treatment of postherpetic neuralgia, and the more recent alternative of an erector spinae plane (ESP) block. Methods: The records of 39 patients who were treated in the algology department for postherpetic neuralgia between May 1, 2015 and May 1, 2018 were evaluated retrospectively. Patients who received an intercostal nerve block constituted Group 1 and those who received an ESP block were categorized as Group 2. The change in numeric rating scale (NRS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores in the short term and in the long term were the primary results of the study. Results: The NRS, LANSS, and sleep interference scale (SIS) scores of the patients in Group 1 and Group 2 were found to be significantly lower at the 24 th hour, week 4, and week 12 compared with the values obtained before block application. In Group 1, the scores recorded at week 4 and week 12 were significantly higher than the 24 th hour values, whereas no difference was observed between these results in Group 2. There was no significant difference between the groups in the week 4 and week 12 scores. Similarly, no significant difference was observed in the NRS, LANSS, or SIS scores before the block application or at the 24 th hour. However, the scores at week 4 and week 12 were significantly lower in Group 2 compared with Group 1. Conclusion: The results indicated that an ESP block significantly decreased neuropathic pain symptoms and the need for additional treatment in postherpetic neuralgia treatment in the long term.

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“…Secondly, ICNBs have minimal risk for procedure-related complications. Complications after ICNBs include pneumothorax, systemic toxic reactions to local anesthetics, abscess formation, and neuritis [ 10 ]. Among them, pneumothorax can be the most severe complication; however, its incidence after ICNBs is rare and has been reported as 0.073–4% [ 35 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…The management of immediate postoperative pain includes the use of intravenous analgesics, botulinum toxin, glucocorticoids, muscle relaxers, nonsteroidal agents, indwelling pain catheters, paravertebral nerve blocks, and intercostal nerve blocks (ICNBs) [ 1 , 4 ]. Among them, ICNBs were introduced in mastectomy by McCann [ 9 ] as an adjunctive to general anesthesia, and the use of ICNBs has been reported to be a safe and effective method to manage immediate postoperative pain in patients undergoing tissue expander reconstruction [ 1 ] and augmentation mammoplasty [ 10 , 11 ]. ICNBs can be performed in breast reconstruction under the direct vision of the intercostal spaces intraoperatively by the operator without an anesthesiologist [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-To-Implant Breast Reconstruction: A Retrospective Study

2020

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Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January 2019 and March 2020, patients who underwent immediate DTI breast reconstruction were included in this study. The patients were divided into the ICNB or control group. In the ICNB group, 4 cc of 0.2% ropivacaine was injected intraoperatively to the second, third, fourth, and fifth intercostal spaces just before implant insertion. The daily average and maximum visual analogue scale (VAS) scores were recorded by the patient from operative day to postoperative day (POD) seven. Pain scores were compared between the ICNB and control groups and analyzed according to the insertion plane of implants. Results: A total of 67 patients with a mean age of 47.9 years were included; 31 patients received ICNBs and 36 patients did not receive ICNBs. There were no complications related to ICNBs reported. The ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 6, p = 0.047), lower maximum VAS scores on the operative day (5 versus 7.5, p = 0.030), and POD 1 (4 versus 6, p = 0.030) as compared with the control group. Among patients who underwent subpectoral reconstruction, the ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 7, p = 0.005), lower maximum VAS scores on the operative day (4.5 versus 8, p = 0.004), and POD 1 (4 versus 6, p = 0.009), whereas no significant differences were observed among those who underwent pre-pectoral reconstruction. Conclusions: Intraoperative ICNBs can effectively reduce immediate postoperative pain in subpectoral DTI breast reconstruction; however, it may not be effective in pre-pectoral DTI reconstruction.

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Postoperative Pain Control by Intercostal Nerve Block After Augmentation Mammoplasty

Cited by 26 publications

References 19 publications

Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The Prospective Randomized FROST Trial

Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The Prospective Randomized FROST Trial

Evaluation of the Efficacy of Erector Spinae Plane Block and Intercostal Nerve Block in the Postherpetic Neuralgia

Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-To-Implant Breast Reconstruction: A Retrospective Study

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