Effectiveness of thoracic paravertebral and intercostal nerve blocks as a part of postoperative analgesia in patients undergoing open cholecystectomy under general anesthesia

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Addis Ababa Universty


Background: Postoperative pain after open cholecystectomy is associated with severe pain. Paravertebral and intercostal block are effective alternative to the gold standard epidural anesthesia for postoperative pain management. Ineffective post cholecystectomy pain management can cause shallow breathing, atelectasis, retention of secretion, and infection of respiratory system. This increase the incidence morbidity, delayed recovery, and hospital stay. Objective: The aim of this study was to asses’ analgesic effectiveness of thoracic paravertebral nerve block (TPVB) and intercostal nerve block (ICB) for management of post cholecystectomy pain as part of postoperative pain management in Addis Ababa hospitals. Methodology: An institutional based prospective cohort study was conducted on 78 patients who fulfill inclusion criteria for open cholecystectomy under general anesthesia. Patients in TPVB group (n=26) received paravertebral block with 0.25% on T7-9, ICB group (n=26) received intercostal nerve block T7-11 while the non-block group (n=26) received no regional nerve block postoperatively for analgesia. Study participants were selected by systematic random sampling technique after proportional allocation to the study hospitals. Data collection methods include preoperative chart review, intraoperative observation and postoperative patient interview starting from recovery room every 6th hours for 24 hours postoperatively. Comparisons of numerical variables between study groups were done using Kruskal Wallis, ANOVA and chi square test. Kruskal wallis with post hoc analysis were used to compare pain score and cumulative analgesic consumption over time and Kaplan Meier survival analysis were used to compare time to first analgesic request using log rank test. Significance was determined at P value <0.05. Result: The postoperative numerical pain rating scale (NRS) score at rest and on coughing were significantly lowered in TPVB and ICB group compared to non-block group with ((H=24.65(2, N=78), p<0.001, η2=0.47) and (H=28.31(2, N=78), p<0.001, η2=0.49) respectively. Time to first analgesic request analgesic request was significantly longer TPVB and ICB compared to non-block with p value <0.001. Particularly the patient in the TPVB Group, median time: 18 hour, 95% CI: [14.59- 21.40] had significantly longer time to first analgesic request compared to ICB group median time: 6 hour 95% CI: [3.7 - 8.2] (p=0.005). The total analgesic consumption in the first 24h was lower in TPVB and ICB. Conclusion and Recommendation: Both TPVB and ICB are effective analgesic techniques for open cholecystectomy with longer and potent postoperative analgesia. However during coughing, thoracic paravertebral block were better than intercostal block. Based on these we recommend use of TPVB and ICB with 0.25% bupivacaine alternatively for post-operative analgesia.



paravertebral block, intercostal block, and open cholecystectomy