The Effect of Preoperative Intercostal Nerve Block on Postoperative Pain after Appendectomy

Kim, Gil Soo; Lee, Yun Sik; Lee, Byung Chul

Abstract

PURPOSE: This prospective study was done to assess the effectiveness of a preoperative intercostal nerve block (ICNB) for postoperative pain relief in patients undergoing an appendectomy. METHODS: In this study, thirty patients were divided into two groups, an ICNB group (n=15) and a control group (n=15), by non-randomized selection. The ICNB group patients had a preoperative ICNB on the right 10th, 11th, and 12th intercostal nerve, each with a mixture of 5 ml 0.25% bupivacaine and 1:200,000 epinephrine. The technical failure rate, the onset time, and side reactions were recorded in ICNB group, and the pain score on the visual analogue scale (VAS), the first injection time of analgesics, and the frequency of analgesics injection within postoperative 24 hours were compared in both groups. RESULTS: In the ICNB patients, the technical failure rate was 28.6%, the mean onset time was 6.7 min, and no serious side reactions were seen in any of the cases. There was also a statistically significant decrease in the pain score on the VAS at the 2nd, 4th, and 8th hours after the appendectomy in the ICNB group compared to control group (P<0.05). In the control group, the pain scores on the VAS were 5.06 at the 2nd hour, 5.03 at the 4th hour, and 4.51 at the 8th hour. In the ICNB group, they were 3.62 at the 2nd hour, 3.32 at the 4th hour, and 3.29 at the 8th hour. CONCLUSION: A preoperative ICNB is not a satisfactory method for postoperative pain relief in patients undergoing an appendectomy due to its short acting time. Hence it is necessary to develop a new long-acting drug with low toxicity for pain relief in patients after receiving an appendectomy.