Korean J Pain.  2019 Apr;32(2):129-132. 10.3344/kjp.2019.32.2.129.

Efficacy of rhomboid intercostal block for analgesia after thoracotomy

Affiliations
  • 1Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey. korgunokmen@gmail.com

Abstract

Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3-T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient's resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.

Keyword

Analgesia; Catheters; Fascia; Intercostal muscle; Thoracotomy; Pain management; Pain measurement; Postoperative pain; Ribs; Rhomboid major muscle; Visual analog scale

MeSH Terms

Analgesia*
Anesthesia, Conduction
Catheters
Fascia
Humans
Intercostal Muscles
Pain Management
Pain Measurement
Pain, Postoperative
Ribs
Thoracotomy*
Visual Analog Scale

Figure

  • Fig. 1 Rhomboid intercostal block. (A) Ultrasound anatomy. (B) An ultrasound-visible block needle was inserted. (C) White stars indicate local anesthesic spread between the rhomboid major muscle and intercostal muscle. (D) White arrow indicates the catheter inserted. Color doppler imaging shows the local anesthesic spread. ICM: intercostals muscle.

  • Fig. 2 The inserted catheter and surgical field.


Cited by  1 articles

Rhomboid intercostal and subserratus plane block -a case series-
Hesham Elsharkawy, Hassan Hamadnalla, Ece Yamak Altinpulluk, Rodney A. Gabriel
Korean J Anesthesiol. 2020;73(6):550-556.    doi: 10.4097/kja.19479.


Reference

1. Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med. 2017; 42:133–83. DOI: 10.1097/AAP.0000000000000545. PMID: 28085788.
2. Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology. 1994; 81:737–59. DOI: 10.1097/00000542-199409000-00028. PMID: 8092520.
3. Elsharkawy H, Saifullah T, Kolli S, Drake R. Rhomboid intercostal block. Anaesthesia. 2016; 71:856–7. DOI: 10.1111/anae.13498. PMID: 27291611.
Article
4. Khalil AE, Abdallah NM, Bashandy GM, Kaddah TA. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth. 2017; 31:152–8. DOI: 10.1053/j.jvca.2016.08.023. PMID: 27939192.
Article
5. Ökmen K, Ökmen BM. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth. 2017; 31:579–85. DOI: 10.1007/s00540-017-2364-9. PMID: 28447227.
Article
6. Elsharkawy H, Maniker R, Bolash R, Kalasbail P, Drake RL, Elkassabany N. Rhomboid intercostal and subserratus plane block: a cadaveric and clinical evaluation. Reg Anesth Pain Med. 2018; 43:745–51. DOI: 10.1097/AAP.0000000000000824. PMID: 30169476.
7. Tulgar S, Thomas DT, Deveci U, Özer Z. Ultrasound guided rhomboid intercostal block provides effective analgesia for excision of elastofibroma extending to the subscapular space: the first report of use in anesthesia practice. J Clin Anesth. 2019; 52:34–5. DOI: 10.1016/j.jclinane.2018.08.015. PMID: 30172021.
Article
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