Continuous wound infiltration with 0.2% ropivacaine versus a single intercostal nerve block with 0.75% ropivacaine for postoperative pain management after reconstructive surgery for microtia.

Abstract

BACKGROUND AND AIM:

In reconstructive surgery for microtia during childhood, costal cartilage is used for pinna formation. Postoperative pain in the region from which the costal cartilage is taken is severe, which delays recovery after surgery. We evaluated prospectively whether continuous wound infiltration (CWI) of a local anesthetic (LA) reduces pain and enables rapid recovery compared with a single intercostal nerve block (ICNB).

METHOD:

Forty-eight patients were randomly divided into two groups. In Group I, a single ICNB with 10 ml of 0.75% ropivacaine was performed at the end of surgery. In Group C, a catheter was inserted into the space between the abdominal external oblique muscle and the rectus abdominis muscle. Then, a 0.4-ml/kg bolus of 0.2% ropivacaine was administered, followed by continuous infusion at 2-4 ml/h for 48 h. Postoperative pain intensity evaluated using the Face Scale, dose of supplemental analgesics, and time until mobilization were evaluated. In Group C, the plasma concentrations of ropivacaine were analyzed.

RESULTS:

The pain intensity at rest was significantly lower in Group C than in Group I, but the values during coughing were comparable. The number of patients receiving a supplemental analgesic and the median number of doses were significantly larger in Group I than in Group C (P = 0.029, P = 0.0007, respectively). The plasma concentrations of ropivacaine were within the safe range over 48 h. The times until mobilization were comparable.

CONCLUSION:

CWI of 0.2% ropivacaine is a better and safe technique for postoperative pain management after costal cartilage graft harvest in children.

• Authors: Yukitoshi Niiyama, Takatoshi Yotsuyanagi, Michiaki Yamakage
• Journal: Journal of plastic, reconstructive & aesthetic surgery : JPRAS (J Plast Reconstr Aesthet Surg) Vol. 69 Issue 10 Pg. 1445-9 (Oct 2016) ISSN: 1878-0539 [Electronic] Netherlands
• PMID: 27350268 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Amides
• Anesthetics, Local
• Ropivacaine

Topics

• Adolescent
• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Child
• Congenital Microtia (surgery)
• Double-Blind Method
• Ear Auricle (surgery)
• Female
• Humans
• Intercostal Nerves (drug effects)
• Male
• Nerve Block (methods)
• Pain Management (methods)
• Pain Measurement
• Pain, Postoperative (diagnosis, therapy)
• Plastic Surgery Procedures (adverse effects, methods)
• Ropivacaine
• Surgical Wound (drug therapy)
• Treatment Outcome