Ultrasound-Guided Intercostal Nerve Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Posted for Open Cholecystectomy: A Randomized Controlled Trial.
Background
Effective postoperative analgesia leads to early mobilization, fewer pulmonary complications, and shorter hospital stay.


Aims
We compared the analgesic effects of ultrasound-guided intercostal nerve (ICN) blocks, subcostal transversus abdominis plane (SCTAP) block, and a control group in open cholecystectomy.


Settings and Design
This was a prospective, randomized controlled, double-blind, multi-arm and parallel study.


Materials and Methods
The study was conducted on patients of American Society of Anaesthesiology Physical Status Classes I and II, either sex, 18-60 years of age, and body mass index 18-30 kg.m-2. Exclusion criteria were infection at the injection site, coagulopathy, thrombocytopenia, and allergy to the drugs used. Group I (n = 41) received ICN blocks, Group T (n = 41) SCTAP block, and Group C (n = 41) no postoperative block. The duration of analgesia was the primary outcome, and the analgesic consumption, the pain intensity, adverse events, and patient satisfaction were the secondary outcomes.


Statistical Analysis
For the continuous data, analysis of variance was used for multiple group comparison and intergroup data were analyzed by Student's t-test. Kruskal-Wallis and Mann-Whitney U tests were applied for ordinal data. P = 0.05 or less was considered statistically significant.


Results
The duration of postoperative analgesia was significantly longer in the ICN (mean = 441.6 min; 95% confidence interval [CI], 407.71, 475.49) and SCTAP block (mean = 417.6 min; 95% CI, 390.94, 444.26) as compared to control (mean = 33.98 min; 95% CI, 26.64, 41.32) (P = 0.00) with no significant intergroup difference between the two intervention groups (P = 0.278). The cumulative analgesic consumption was not significantly different between the intervention groups but was significantly reduced in the study groups when compared with the control group (P < 0.001). No notable adverse events were observed. Patients with both the techniques were very satisfied in comparison with the control group (P = 0.00).


Conclusion
Both the ICN and SCTAP blocks have similar results in terms of analgesia and patient satisfaction for cholecystectomy.
['Swati|Srivastava|S|', 'Shagufta|Naaz|N|', 'Erum|Ozair|O|', 'Adil|Asghar|A|', 'Urvashi|Yadav|Y|']
intercostal nerve Early ambulation pain management postoperative pain prospective studies