Intercostal nerve block with thoracoabdominal and flank incisions.

A double-blind study was done in 90 patients undergoing a rib-resecting thoracoabdominal incision for testicular cancer or a flank incision for renal surgery to determine the effect of intraoperative intercostal nerve block with bupivacaine hydrochloride on postoperative pain and complications, day of ambulation, and day of oral fluid intake. In the patients treated with bupivacaine, we found a significant reduction in the amount of postoperative analgesia required, but no difference in the day of ambulation or fluid intake. Ten of 45 patients given a placebo nerve block experienced postoperative atelectasis, whereas only 4 of 45 patients in the treated group experienced this complication. We believe that intercostal nerve block is a valuable postoperative adjuvant in patients undergoing flank surgery to reduce the postoperative analgesic requirements and incidence of atelectasis.