Randomised controlled study on effect of intercoastal nerve block on hemodynamics of patients

undergoing closed mitral valvotomy

Introduction:

Intercostal nerve block is simple procedure and has been used effectively for providing analgesia to
patients undergoing various surgical procedures on thorax including lung resection, mastectomy,
minimal invasive mitral valve surgery, augmentation mammoplasty and video assisted thoracoscopy.1-6

Intrathoracic procedures using a thoracotomy incision are associated with severe pain.2 Inadequate
control of pain in perioperative period causes significant morbidity like tachycardia, hypertension,
myocardial infarction, hypoxia impaired pulmonary function and decreased patient satisfaction.?

Closed mitral valvotomy is done for patients with severe mitral stenosis through a lateral thoracotomy
incision, generally at 5th intercostal space. Perioperative pain due to thoracotomy in these patients can
lead to tachycardia which can adversely affect the hemodynamics of the patient causing pulmonary
edema, decreased cardiac output and hypotension.7,8 . Increasing the depth of anesthesia for controlling
the heart rate can lead to hypotension due to hypotensive effect of anesthetic drugs.

Intercostal nerve block can avoid these problems arising out of inadequate analgesia as in can inhibit
somatic component of thoracotomy pain. So we have devised this trial to test our hypothesis that
intercostal nerve block reduces postoperative pain after closed mitral valvotomy.

1. J Exerc Rehabil. 2014 Aug; 10(4): 241–244. Published online 2014 Aug 31. doi:
10.12965/jer.140137 PMCID: PMC4157932 Effectiveness of intercostal nerve block for
management of pain in rib fracture patients Eun Gu Hwang1 and Yunjung Lee2,*
2. Ann Thorac Surg. 2005 Oct;80(4):1550-9. Efficacy of methods of intercostal nerve blockade for
pain relief after thoracotomy. Detterbeck FC1.
3. A randomized prospective study of analgesic quality after thoracotomy: paravertebral block with
bolus versus continuous infusion with an elastomeric pump Juan J. Fibla Laureano Molins José
M. Mier Jorge Hernandez Ana Sierra European Journal of Cardio-Thoracic Surgery, Volume 47,
Issue 4, 1 April 2015, Pages 631–635,
4. J Plast Surg Hand Surg. 2014 Feb;48(1):51-5. doi: 10.3109/2000656X.2013.800529. Epub 2013
Dec 11. Combined usage of intercostal nerve block and tumescent anaesthesia: an effective
anaesthesia technique for breast augmentation.
5. Exp Ther Med. 2017 Oct; 14(4): 3259–3264.Published online 2017 Aug 2. doi:
10.3892/etm.2017.4868 PMCID: PMC5585755Effect of intercostal nerve block combined with
general anesthesia on the stress response in patients undergoing minimally invasive mitral valve
surgery Yanping Zhan,1 Guo Chen,2 Jian Huang,1 Benchao Hou,1 Weicheng Liu,1 and Shibiao
Chen1
6. Ann Thorac Surg. 2015 Jun;99(6):1953-60. doi: 10.1016/j.athoracsur.2015.02.074. Epub 2015
Apr 23. Posterior Intercostal Nerve Block With Liposomal Bupivacaine: An Alternative to
Thoracic Epidural Analgesia. Rice DC1, Cata JP2, Mena GE2, Rodriguez-Restrepo A2, Correa AM3,
Mehran RJ3.
7. Indian J Anaesth. 2017 Sep;61(9):721-727. doi: 10.4103/ija.IJA_378_17. Valvular heart disease
and anaesthesia. Paul A1, Das S1.
8. Ann Card Anaesth. 2002 Jan;5(1):53-8. A comparative evaluation of thoracic and lumbar epidural
fentanyl for post thoracotomy pain. Swaroop NS1, Batra YK, Bhardwaj N, Chari P, Ram P.
9.