BRILMA block for costal cartilage excision: Case report

• Published in: Revista española de anestesiología y reanimación 2020-05, Vol.67 (5), p.271-274
• Main Authors: Silva Pereira, T, Rodrigues Silva, C, Veiga, N F, Alfaro de la Torre, P, Kabiri-Sacramento, M
• Format: Article
• Language: eng ; spa
• Subjects: Anesthetics, Local - administration & dosage; Costal Cartilage - surgery; Female; Humans; Intercostal Muscles - innervation; Intercostal Nerves - anatomy & histology; Intermediate Back Muscles; Laryngostenosis - surgery; Middle Aged; Nerve Block - methods; Pain, Postoperative - drug therapy; Ropivacaine - administration & dosage; Surgical Flaps
• ISSN: 2340-3284; 2341-1929
• DOI: 10.1016/j.redar.2020.01.009

The block of the lateral branches of the intercostal nerves in the middle axillary line (BRILMA) is an interfascial ultrasound-guided block for analgesia in thoracic wall and upper abdominal surgery, presenting as an adequate alternative to neuraxial techniques. We present the case of a 49-year-old female scheduled for idiopathic subglottic stenosis repair with a costal cartilage graft from the 10 rib and tracheotomy. At the end of the surgery, unilateral ultrasound-guided BRILMA block with 20ml of ropivacaine 0.2% was performed at the level of the 6 rib, uneventfully. Postoperatively, the patient referred a maximum level of pain of 3/10. There was no opioid consumption after the 2 postoperative day, although a subcostal incision may produce considerable pain. BRILMA is a superficial block, easily reproducible in most patients. It diminishes the number of punctures needed in the thoracic wall, as well as the risk for pneumothorax and local anesthetic toxicity.