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

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 69; no. 9; pp. 1203 - 1210
• Main Authors: Woo, Kyong-Je, M.D, Kang, Bo Young, M.D, Min, Jeong Jin, M.D, Park, Jin-Woo, M.D, Kim, Ara, M.D, Oh, Kap Sung, M.D
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2016
• Subjects: Anesthetics, Local - administration & dosage; Catheter; Catheterization - methods; Child; Congenital Microtia - surgery; Costal Cartilage - transplantation; Female; Follow-Up Studies; Humans; Intercostal nerve block; Intercostal Nerves; Male; Microtia; Nerve Block - methods; Otologic Surgical Procedures - methods; Pain control; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - therapy; Plastic Surgery; Preventive analgesia; Prospective Studies; Reconstructive Surgical Procedures - methods; Rib cartilage graft; Ribs - surgery; Tissue and Organ Harvesting; microtia; intercostal nerve block; catheter; preventive analgesia; pain control; rib cartilage graft; Catheter; Rib cartilage graft; Microtia; Pain control; Intercostal nerve block; Preventive analgesia
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2016.06.026

Abstract Background Children with microtia complain of severe postoperative pain during early postoperative days after rib cartilage harvest for auricular reconstruction. The purpose of this study was to evaluate the effects of preventive donor site wound analgesia by intercostal nerve block (ICNB) and catheter-based infusion of local analgesics on postoperative pain after rib cartilage graft for auricular reconstruction in children with microtia. Methods In this prospective randomized study, 66 children underwent postoperative pain control using either preventive ICNB followed by catheter based infusion (33 patients, study group) or intravenous analgesia alone (33 patients, control group). ICNB was performed under direct vision by the surgeon by injecting 0.5% bupivacaine into each of the three intercostal spaces before perichondrial dissection. Catheters were placed in three subchondral spaces before wound closure, and 0.5% bupivacaine was infused every 12 hours for 48 hours postoperatively. Pain degrees were recorded every four hours during the first 48 postoperative hours using a visual analogue scale (VAS). Results The study group showed significantly lower mean pain scores of the chest at rest (3.7 vs. 5.1, p = 0.001), the chest during coughing (4.3 vs. 5.8, p = 0.006), and the ear (3.0 vs. 4.1, p = 0.001). The amount of rescue intravenous ketorolac use was smaller in the study group ( p = 0.026). No side effects related to the intervention were noted. Conclusions Preventive ICNB followed by catheter based infusion is effective and safe in postoperative pain relief in rib cartilage graft for auricular reconstruction.