Muhammad Mustehsan Bashir, Muhammad Ateeq Shahzad, Muhammad Nadeem Yousaf, Bilal Ahmad Khan, Farid Ahmad Khan.
Comparison of postoperative pain relief by intercostal block between pre-rib harvest and post-rib harvest groups.
J Coll Physicians Surg Pak Jan ;24(1):43-6.

Objective: To compare intercostal nerve block before and after rib harvest in terms of mean postoperative pain score and mean postoperative tramadol usage. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Plastic Surgery, Mayo Hospital, KEMU, Lahore, from January 2011 to July 2012. Methodology: Patients (n = 120) of either gender with ASA class-I and II requiring autogenous costal cartilage graft were inducted. Patients having history of local anaesthetic hypersensitivity and age < 15 years or > 60 years were excluded. Subjects were randomly assigned to pre-rib harvest (group-1) and post-rib harvest (group-2). Local anaesthetic mixture was prepared by adding 10 milliliters 2% lidocaine to 10 milliliters 0.5% bupivacaine to obtain a total 20 ml solution. Group-1 received local anaesthetic infiltration along the proposed incision lines and intercostals block before the rib harvest. Group-2 received the infiltration and block after rib harvest. Postoperative consumption of tramadol and pain scores were measured at 6 and 12 hours postoperatively using VAS. Results: Mean age was 31.43 + 10.78 years. The mean pain scores at 6 hours postoperatively were 1.033 + 0.609 and 2.4667 + 0.812 in pre-rib harvest and post-rib harvest groups respectively (p<0.0001). The mean pain scores at 12 hours postoperatively were 1.45 + 0.565 and 3.65 + 0.633 in pre-rib harvest and post-rib harvest groups respectively (p<0.0001). The mean tramadol used postoperatively in first 24 hours was 169 + 29.24 mg and 255 + 17.70 mg in pre-rib harvest and post-rib harvest groups respectively (p<0.0001). Conclusion: Intercostal block administered before rib harvest as preemptive strategy result in decreased postoperative pain scores and narcotic use.

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