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The Efficacy of Intercostal Nerve Block in the Management of Postoperative Pain After Costal Cartilage Harvest for Craniofacial Reconstruction Systematic Review and Meta-analysis

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  • Craniofacial/Maxillofacial
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Abstract

Introduction

Autologous costal cartilage harvest is a common procedure in craniofacial reconstruction due to its stability, dependability, and diversity. However, such a procedure is associated with severe donor-site pain postoperatively. Therefore, we aim through this study to compare the efficacy of intercostal nerve block in the management of postoperative pain in patients undergoing costal cartilage harvest for craniofacial reconstruction.

Method

This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without time-limitation.

Results

As a result of reviewing the literature, 33 articles were screened by full-text resulting in 14 articles which met our inclusion/exclusion criteria. However, only four high-quality RCT articles were included in the quantitative synthesis (meta-analysis). The findings of this study suggest that there is no significant difference in pain scores between ICNB and control groups at 12, 24, and 48 h postoperatively, both at rest and with coughing. Therefore, both techniques are considered safe and effective.

Conclusion

Our results show evidence of favorable outcome of preventive donor-site analgesia with ICNB for harvesting autologous costal cartilage in multiple studies. However, the overall outcomes were insignificant between the two arms.

No Level Assigned

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References

  1. Fu YY et al (2020) Ultrasonographic evaluation of costal cartilage for microtia reconstruction surgery. Int J Pediatr Otorhinolaryngol 137:110234. https://doi.org/10.1016/j.ijporl.2020.110234

    Article  PubMed  Google Scholar 

  2. Niiyama Y, Yotsuyanagi T, Yamakage M (2016) 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. J Plast, Reconstr Aesthet Surg 69(10):1445–1449. https://doi.org/10.1016/j.bjps.2016.05.009

    Article  PubMed  Google Scholar 

  3. Harbaugh CM, Lee JS, Hu HM et al (2018) Persistent opioid use among pediatric patients after surgery. Pediatrics 141(1):e20172439. https://doi.org/10.1542/peds.2017-2439

    Article  PubMed  Google Scholar 

  4. Woo KJ, Kang BY, Min JJ, Park JW, Kim A, Oh KS (2016) Postoperative pain control by preventive intercostal nerve block under direct vision followed by catheter-based infusion of local analgesics in rib cartilage harvest for auricular reconstruction in children with microtia: A randomized controlled trial. J Plast Reconstr Aesthet Surg 69(9):1203–1210. https://doi.org/10.1016/j.bjps.2016.06.026

    Article  PubMed  Google Scholar 

  5. Anantanarayanan P, Raja DK, Kumar JN et al (2013) Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine. J Oral Maxillofac Surg 71(1):29–34. https://doi.org/10.1016/j.joms.2012.08.010

    Article  PubMed  Google Scholar 

  6. Dong W, Wang X, Wang H et al (2022) Comparison of multimodal cocktail to ropivacaine intercostal nerve block for chest pain after costal cartilage harvest: a randomized controlled trial. Facial Plast Surg Aesthet Med. 24(2):102–108. https://doi.org/10.1089/fpsam.2021.0264

    Article  PubMed  Google Scholar 

  7. The PRISMA Group, Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed Central  Google Scholar 

  8. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  PubMed  Google Scholar 

  9. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid-Based Med 23(2):60–63. https://doi.org/10.1136/bmjebm-2017-110853

    Article  PubMed  PubMed Central  Google Scholar 

  10. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gomez G, Osterbauer B, Nguyen R et al (2022) Microtia reconstruction and erector spinae block in children: a case series with chart review. Otolaryngol Head Neck Surg 166(2):382–387. https://doi.org/10.1177/01945998211018382

    Article  PubMed  Google Scholar 

  12. Guoyu J, Tao W, Xi Y (2022) Application of methylene blue combined with ropivacaine intercostal nerve block in postoperative analgesia of autologous costal cartilage augmentation rhinoplasty. Anwendung von Methylenblau in Kombination mit der Interkostalnervenblockade mit Ropivacain auf die postoperative Analgesie nach Augmentationsrhinoplastik mit autologem Rippenknorpel. Anaesthesiologie 71(Suppl 2):233–239. https://doi.org/10.1007/s00101-022-01222-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Liu Y, Ren J, Sun P, Lu X, Chen Z (2022) Methylene blue combined with ropivacaine for intercostal nerve block after autologous costal cartilage removal in Juvenile patients. Aesthetic Plast Surg 46(6):3094–3100. https://doi.org/10.1007/s00266-022-03079-z

    Article  PubMed  Google Scholar 

  14. Epperson MV, VanHorn A, Kim HM, Kim JC, Zopf D (2022) Pain management after microtia repair with costal cartilage: de-escalation and opioid use reduction. Int J Pediatr Otorhinolaryngol 161:111270. https://doi.org/10.1016/j.ijporl.2022.111270

    Article  PubMed  Google Scholar 

  15. Uppal RS, Sabbagh W, Chana J, Gault DT (2008) Donor-site morbidity after autologous costal cartilage harvest in ear reconstruction and approaches to reducing donor-site contour deformity. Plast Reconstr Surg 121(6):1949–1955. https://doi.org/10.1097/PRS.0b013e318170709e

    Article  CAS  PubMed  Google Scholar 

  16. Chen C, Xiang G, Chen K et al (2022) Ultrasound-guided bilateral serratus anterior plane block for postoperative analgesia in ear reconstruction after costal cartilage harvest: a randomized controlled trial. Aesthetic Plast Surg 46(4):2006–2014. https://doi.org/10.1007/s00266-022-03027-x

    Article  PubMed  Google Scholar 

  17. Dong W, Wang X, Wang H et al (2022) A prospective study of multimodal cocktail intercostal injection for chest pain relief after costal cartilage harvest for rhinoplasty. Br J Oral Maxillofac Surg 60(6):841–846. https://doi.org/10.1016/j.bjoms.2021.12.054

    Article  PubMed  Google Scholar 

  18. Bashir MM, Shahzad MA, Yousaf MN, Khan BA, Khan FA (2014) Comparison of postoperative pain relief by intercostal block between pre-rib harvest and post-rib harvest groups. J Coll Physicians Surg Pak 24(1):43–46

    PubMed  Google Scholar 

  19. Lin C, Darling C (2018) Erector spinae plane catheters for pain management of rib cartilage harvesting for stage 1 microtia reconstruction: a retrospective study. Society for Pediatric Pain Medicine: Fall 2018. https://www.pedspainmedicine.org/wp-content/uploads/newsletters/2018/fall/asapresents/erectorspinae.html

  20. Chen C, Xiang G, Liu Q et al (2022) Ultrasound-guided serratus anterior plane block, along with improved parasternal block, is superior to serratus anterior plane block alone in relieving pain for rhinoplasty with autologous costal cartilage. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-022-03230-w

    Article  PubMed  PubMed Central  Google Scholar 

  21. Strømskag KE, Kleiven S (1998) Continuous intercostal and interpleural nerve blockades. Tech Reg Anesth Pain Manag 2(2):79–89. https://doi.org/10.1016/S1084-208X(98)80015-3. (ISSN 1084-208X)

    Article  Google Scholar 

  22. Guerra-Londono CE, Privorotskiy A, Cozowicz C et al (2021) Assessment of intercostal nerve block analgesia for thoracic surgery: a systematic review and meta-analysis. JAMA Netw Open 4(11):e2133394. https://doi.org/10.1001/jamanetworkopen.2021.33394

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shanti CM, Carlin AM, Tyburski JG (2001) Incidence of pneumothorax from intercostal nerve block for analgesia in rib fractures. J Trauma 51(3):536–539. https://doi.org/10.1097/00005373-200109000-00019

    Article  CAS  PubMed  Google Scholar 

  24. Kehlet H, Dahl JB (1993) The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg 77(5):1048–1056. https://doi.org/10.1213/00000539-199311000-00030

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia

    Nawaf Alhindi, Ziyad Tarek Almalki, Ahmed Samir Moamina & Ahmed Sulaiman Alsaedi

  2. Faculty of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia

    Muna F. Alnaim

  3. Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia

    Basma Bamakhrama

  4. Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia

    Basma Bamakhrama

  5. Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Khalid Arab

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  1. Nawaf Alhindi
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  2. Muna F. Alnaim
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Correspondence to Nawaf Alhindi.

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Alhindi, N., Alnaim, M.F., Almalki, Z.T. et al. The Efficacy of Intercostal Nerve Block in the Management of Postoperative Pain After Costal Cartilage Harvest for Craniofacial Reconstruction Systematic Review and Meta-analysis. Aesth Plast Surg 48, 803–815 (2024). https://doi.org/10.1007/s00266-023-03621-7

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