title: [Effectiveness of intercostal nerve block with ropivacaine in analgesia of patients undergoing emergency open cholecystectomy under general anesthesia].
abstract: BACKGROUND
  Postoperative pain after open cholecystectomy is associated with reduced respiratory function, longer recovery period before deambulation and oral food intake, and prolonged hospital stay. Intercostal nerve block provides satisfactory analgesia and ropivacaine is the most widely used local anesthetic agent in intercostal nerve block due to its excellent effectiveness, lower cardiovascular toxicity, and longer half-life.
  
  
  OBJECTIVE
  To evaluate intercostal nerve block effectiveness with ropivacaine in patients undergoing emergency open cholecystectomy under general anesthesia compared with conventional management.
  
  
  METHODS
  A controlled clinical trial was carried out on 50 patients undergoing open cholecystectomy, 25 patients without intercostal nerve block versus 25 patients with intercostal nerve block using ropivacaine at 0.5% combined with epinephrine. Intraoperative minimum alveolar concentration and inhalation anesthetic use were evaluated. Tramadol as rescue analgesic agent and pain were evaluated during immediate postoperative period by means of the Visual Analog Scale at 8, 16, and 24 hours.
  
  
  RESULTS
  Mean inhalation anesthetic use was lower in the intercostal nerve block group with 13% vs 37% in the group without intercostal nerve block (p= 0.01). Rescue tramadol requirement was lower in the intercostal nerve block group than in the group without intercostal nerve block at 8 hours (8% vs 67%), 16 hours (0% vs 83%), and 24 hours (12% vs 79%) (p<0.0001). Visual Analog Scale for Pain results were similar in both groups.
  
  
  CONCLUSIONS
  Intercostal nerve block reduces intraoperative inhalation anesthetic use, immediate postoperative pain, and tramadol intake as rescue analgesic agent in patients undergoing open cholecystectomy.
authors.affiliation: Servicio de Cirugía General, Hospital Regional "Lic. Adolfo López Mateos". Av. Universidad N° 1321. Col. Florida, Delegación Álvaro Obregón, C.P. 01030. México D.F., México. vizromedic@yahoo.com.mx
authors.forename: M A
authors.initials: MA
authors.lastname: Vizcarra-Román
authors.forename: J A
authors.initials: JA
authors.lastname: Bahena-Aponte
authors.forename: A
authors.initials: A
authors.lastname: Cruz-Jarquín
authors.forename: Ja C
authors.initials: JC
authors.lastname: Vázquez-García
authors.forename: L E
authors.initials: LE
authors.lastname: Cárdenas-Lailson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D000698:Analgesia / Q000379:methods*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002763:Cholecystectomy / Q000379:methods; D003430:Cross-Sectional Studies; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007367:Intercostal Nerves; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine