Effectiveness of thoracic paravertebral and intercostal nerve blocks as a part of postoperative analgesia in patients undergoing open cholecystectomy under general anesthesia in Addis Ababa, Ethiopia: A prospective cohort study, 2018

Abstract

BackgroundPostoperative pain after open cholecystectomy is associated with severe pain. Ineffective post-cholecystectomy pain management can cause shallow breathing, atelectasis, retention of secretion, and infection of respiratory system. This study asses’ analgesic effectiveness of thoracic paravertebral nerve block (TPVB) and intercostal nerve block (ICB) for open cholecystectomy postoperative pain management. MethodologyAn institutional based prospective cohort study was conducted in selected hospitals. Using systematic random sampling technique, seventy-eight (78) patients that underwent open cholecystectomy under general anesthesia and fulfilled the inclusion criteria were selected. Based on the responsible anesthetist's postoperative pain management plan, patients were divided into three groups. Patients who received TPVB at the end of surgery represent TPVB group and those patients that received ICB at the end of surgery grouped as ICB group. Patients who did not receive any regional block for postoperative pain management considered as the non-block group. ResultThe postoperative NRS score at rest and on coughing were significantly lowered in TPVB and ICB group compared to non-block group with p value < 0.001. Time to first analgesic request was significantly longer in TPVB and ICB compared to non-block with p value < 0.001. The total analgesic consumption in the first 24 h was lower in TPVB and ICB. ConclusionBoth TPVB and ICB are effective analgesic techniques for open cholecystectomy with longer and potent postoperative analgesia. During coughing the thoracic paravertebral block recorded lesser pain score than intercostal block. Based on our study we recommend TPVB and ICB for post-operative analgesia for open cholecystectomy.