مقایسه بی دردی بلوک بین دنده ای به همراه تزریق مداوم مورفین وریدی با تزریق مداوم مورفین وریدی به تنهایی در کاهش درد بعد از عمل در جراحی کله سیستکتومی باز

Abstract: Aims and Background: Open cholecystectomy has many complications like respiratory dysfunction and stress response because of pain. The aim of this study was to compare the efficacy of intercostal nerve block added to intravenous infusion of morphine with sole intravenous morphine infusion on pain control after open cholecystectomy. Methods and Materials: 100 patients, candidate for open cholecystectomy, were randomly divided into two groups of 50. The patients underwent elective cholecystectomy by Kocher’s (Subcostal) incision and were randomly allocated to any of the following two groups. The intervention group received intercostal nerve block with 0.25 milligram per kilogram of 0.25% bupivacaine which was infiltrated into the subcostal 6th to 10th rib margin. Then intravenous infusion of 0.5 milligram per kilogram morphine was also started for them. In the control Group, patients had intravenous infusion of 0.5 milligram per kilogram morphine. The infusion rate was 5 milliliter per hour in both group. When the patients were transferred to postoperative recovery room, intensity of pain was recorded by response from the patients using 100 mm linear visual analogue scale(VAS) ranging from 0 to 100. The pain scoring was done at 30 minutes, 6 hours, 12 hours, 18 hours and 24 hours postoperatively. Findings: In our study the severity of pain was lower at 30 minutes, 6 hours, 12 hours, and 18 hours in the intercostal nerve block group than the control group. But at 24 hours postoperatively no significant difference was shown between the groups. Conclusions: Adding Intercostal nerve block to intravenous infusion of morphine is better than sole intravenous infusion of morphine in controling pain severity after open cholecystectomy. Keywords: intercostal nerve block, pain, morphine, opens cholecystectomy.