title: Comparison of postoperative pain relief by intercostal block between pre-rib harvest and post-rib harvest groups.
abstract: OBJECTIVE
  To compare intercostal nerve block before and after rib harvest in terms of mean postoperative pain score and mean postoperative tramadol usage.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Department of Plastic Surgery, Mayo Hospital, KEMU, Lahore, from January 2011 to July 2012.
  
  
  METHODS
  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 prerib harvest and post-rib harvest groups respectively (p < 0.0001).
  
  
  CONCLUSIONS
  Intercostal block administered before rib harvest as preemptive strategy result in decreased postoperative pain scores and narcotic use.
authors.affiliation: Department of Plastic Surgery, King Edward Medical University, Mayo Hospital, Lahore.
authors.forename: Muhammad Mustehsan
authors.initials: MM
authors.lastname: Bashir
authors.affiliation: Department of Plastic Surgery, King Edward Medical University, Mayo Hospital, Lahore.
authors.forename: Muhammad Ateeq
authors.initials: MA
authors.lastname: Shahzad
authors.affiliation: Department of Plastic Surgery, King Edward Medical University, Mayo Hospital, Lahore.
authors.forename: Muhammad Nadeem
authors.initials: MN
authors.lastname: Yousaf
authors.affiliation: Department of Plastic Surgery, King Edward Medical University, Mayo Hospital, Lahore.
authors.forename: Bilal Ahmad
authors.initials: BA
authors.lastname: Khan
authors.affiliation: Department of Plastic Surgery, King Edward Medical University, Mayo Hospital, Lahore.
authors.forename: Farid Ahmad
authors.initials: FA
authors.lastname: Khan
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000187:drug effects*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012272:Ribs / Q000637:transplantation*; D020858:Tissue and Organ Harvesting; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D008012:Lidocaine; D002045:Bupivacaine