The effect of anaesthesia on flank incisional pain: infiltration versus intercostal nerve block, a comparative study

Abstract

The object of this study is to determine which local wound analgesic option is superior, local anaesthetic infiltration or intercostal nerve block, by combined local anaesthetic agents (0.5% bupivacaine + 2% lidocaine) and to detect which option can best alleviate the post-operative pain management and significantly prolong the time to the first rescue analgesic requirement and the total consumption of opioids in the first post-operative 72 hrs. The medical records of 1458 patients who underwent flank incision procedures by two different surgeons in our institute were retrospectively reviewed. Each surgeon used a different type of local incisional pain management; the first one used infiltration of flank incision routinely, the second surgeon used an intercostal block with all his patients. These elective procedures were carried out in our Urology Centre between June 2007 and June 2019. The duration of follow-up was from the recovery transfer until the end of the third post-operative day. Patients were divided into two groups: group 1 (729 patients-infiltration of flank incision) and group 2 (729 patients-intercostal nerve block). Patients were aged between 19-78 years. No significant differences were seen regarding the demographic data between both groups, P = 0.05. On the other hand, there were significant differences between group 1 and group 2 according to the mean visual analogue scale score (lower in group 1, P = 0.05), the total mean analgesic requirements during the first post-operative 72 hrs (lower in group 1, P = 0.05) and the time to the first analgesic demand (higher in group 1, P = 0.05). There were no statistically significant differences in post-operative complications between both groups, P = 0.05. The infiltration of flank incision with combined local anaesthetic agents (0.5% Bupivacaine + 2% lidocaine) is more effective in alleviating post-operative pain, decreasing total analgesic consumption during the first post-operative 72 hrs and prolonging the time required for the first rescue opioid.

Keywords

• flank incision
• local anaesthesia
• wound infiltration
• intercostal nerve block