The analgesic effects of intercostal nerve block in patients undergoing augmentation mammoplasty - MDbP 203

Sangdal Lee; Samhee Kwon

doi:10.4048/jbc.2006.9.4.349

Journal List > J Breast Cancer > v.9(4) > 1036805

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee and Kwon: The analgesic effects of intercostal nerve block in patients undergoing augmentation mammoplasty - MDbP 203

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2006; 9(4): 349-353.

Published online: 31 December 2006

DOI: https://doi.org/10.4048/jbc.2006.9.4.349

The analgesic effects of intercostal nerve block in patients undergoing augmentation mammoplasty - MDbP 203

Sangdal Lee, Samhee Kwon

M.D. Clinic

dahl65@hanmail.net

Received 6 September 2006 Accepted 10 November 2006

Abstract

Purpose

Augmentation mammoplasty is a procedure that expands the breast tissue and pectoral muscle by insertion of an implant. This procedure induce extreme postoperative pain. The purpose of this study was to determine whether intercostal nerve block (ICNB) could reduce the pain after augmentation mammoplasty.

Methods

Eighty three patients, who underwent augmentation mammoplasty, at the M.D. Clinic between December 2005 and February 2006, were the cases of this study. We injected 0.25% ropivacaine (total 30ml per side) in the ICNB group (n=68) into the 3,4,5 and 6th intercostals spaces following induction of general anesthesia for surgery. The mean arterial pressures and heart rates were measured before and after subpectoral dissection. A numerical rating scale (NRS: 0=no pain, 10= most severe pain) was used to measure the pain postoperative 6, 24, 48 hours, respectively. We statistically compared the ICNB group with the control group (n=15) with using the Mann-Whitney Rank Sum test.

Results

The mean arterial pressures and heart rates were more stable during subpectoral dissection in the ICNB group than in the control group (p= 0.142 and p= 0.037). The NRSs were lower throughout the 48 hours of the postoperative period in the ICNB group than in the control group (p<0.001 at 6hr, p=0.017 at 24hr, p=0.054 at 48hr).

Conclusion

ICNB induced stable vital sign during subpectoral dissection and excellent postoperative pain control during 48 hours postoperatively for those patients undergoing augmentation mammoplasty.

Keywords: intercostal nerve block, augmentation mammoplasty

Figures and Tables

Fig 1

Intercostal nerve block. Injection of 0.25% ropivacaine into the 3,4,5 and 6th intercostals spaces.

Fig 2

Changes of mean arterial pressure after subpectoral dissection

Fig 3

Change of heart rate after subpectoral dissection

Fig 4

Time course changes of postoperative numerical rating scale.

Table 1

Characteristics of cases.

ICNB=intercostal newe block; Ax=axillany; Ar=Arenlen

^*operation time of cases after exception of 6 cases of dual plane technic for ptosis

References

1. Perttunen K, Nilsson E, Heinonen J, Hirvisalo EL, Salo JA, Kalso E. Extradural, paravertebral and intercostals nerve blocks for post-thoracotomy pain. Br J Anaesth. 1995. 75:541–547.

2. Tschernko EM, Klepetko H, Grunder E, Kritzinger M, Klimscha W, Jandrasits O, et al. Clonidine added to the anesthetic solution enhances analgesia improves oxygenation after intercostals nerve block for thoracotomy. Anesth Analg. 1998. 87:107–111.

3. Pacik PT, Werner C. Pain control in augmentation mammaplasty: the use of indwelling catheters in 350 consecutive patients. Plast Reconstr Surg. 2005. 115:575–577.

4. Pacik PT, Werner C, Jackson N, Lobsitz C. Pain control in augmentation mammaplasty: The use of indwelling catheters in 200 consecutive patients. Plast Reconstr Surg. 2003. 111:2090–2096.

5. Papanastasiou S, Evans J. Postoperative analgesia in augmentation mammaplasty. Plast Reconstr Surg. 2000. 105:1241.

6. Schneider MS. Pain reduction in breast augmentation using methocarbamol. Aesthetic Plast Surg. 1997. 21:23–24.

7. Huang TT, Parks DH, Lewis SR. Outpatient breast surgery under intercostals block anesthesia. Plast Reconstr Surg. 1979. 62:299–303.

8. Atanassoff PG, Alon E, Pasch T, Ziegler WH, Gautschi K. Intercostal nerve block for minor breast surgery. Reg Anesth. 1991. 16:23–27.

9. Kolawole IK, Adesina MD, Olaoye IO. Intercostal nerve block for mastectomy in two patients with advanced breast malignancy. J Natl Med Assoc. 2006. 98:450–453.

10. Craig DB. Postoperative recovery of pulmonary function. Anesth Analg. 1981. 60:46–52.

11. Conacher ID. Pain relief after thoracotomy. Br J Anaesth. 1990. 65:806–812.

12. Shim KD, Kwon SY, Lee JS, Lee JI, Chang DJ, Lee YW. The analgesic effects of intercostals nerve block in patients undergoing total ear reconstruction. Korean J Anesth. 2003. 46:170–174.

13. McClure JH. Ropivacaine. Br J Anaesth. 1996. 76:300–307.

14. Whiteside JB, Wildsmith JA. Developments in local anaesthetic drugs. Br J Anaesth. 2001. 87:27–35.

15. Budzynski TH, Stoyva JM, Adler CS, Mullaney DJ. EMG biofeedback and tension headache: a controlled outcome study. Psycosom Med. 1973. 35:484–496.

16. Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975. 1:277–299.

17. Bernards CM. Barash PG, Cullen BF, Stoelting RK, editors. Epidural and spinal anesthesia. Clinical Anesthesia. 2001. 4th ed.Philadelphia: Lippincott Williams & Wilkins;702.

18. Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. Br J Anaesth. 1993. 70:434–439.

19. Doyle E, Bowler GM. Pre-emptive effect of multimodal analgesia in thoracic surgery. Br J Anaesth. 1998. 80:147–151.

20. Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993. 77:362–379.

21. Moore DC. Pneumothorax. Its incidence following intercostals nerve block. JAMA. 1962. 182:1005–1008.

TOOLS

Similar articles