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Vol. 67. Issue 5.
Pages 271-274 (May 2020)
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Vol. 67. Issue 5.
Pages 271-274 (May 2020)
Case report
BRILMA block for costal cartilage excision: Case report
Bloqueo BRILMA para extirpación de cartílago costal: caso clínico
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T. Silva Pereiraa,
Corresponding author
teresasrspereira@gmail.com

Corresponding author.
, C. Rodrigues Silvaa, N.F. Veigab, P. Alfaro de la Torrec, M. Kabiri-Sacramentod
a Departamento de Anestesiología, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
b Departamento de Anestesiología, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
c Departamento de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Joan XXIII, Tarragona, Spain
d Departamento de Anestesiología, Hospital Infanta Leonor, Madrid, Spain
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Abstract

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 10th 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 6th rib, uneventfully. Postoperatively, the patient referred a maximum level of pain of 3/10. There was no opioid consumption after the 2nd 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.

Keywords:
Pain management
Acute pain
Intercostal nerves
Local anesthetic
Thoracic wall
Resumen

El bloqueo de las ramas laterales de los nervios intercostales en la línea axilar media (BRILMA) es un bloqueo ecoguiado interfascial para la analgesia en cirugía torácica y abdominal, y es una buena alternativa a las técnicas neuroaxiales. Presentamos el caso de una mujer de 49 años programada para reparación de estenosis idiopática subglótica, con extracción de cartílago costal de la décima costilla y traqueotomía. Tras la cirugía se realizó sin incidencias el bloqueo BRILMA unilateral con 20ml de ropivacaína al 0,2% a nivel de la 6.ª costilla. En el postoperatorio, la paciente refirió un máximo de dolor de 3/10. No requirió opioides tras el segundo día postoperatorio, aunque una incisión subcostal puede producir dolor de considerable intensidad. BRILMA es una técnica superficial, fácilmente reproducible en la mayoría de los pacientes. Mediante una sola punción se logra alcanzar analgesia efectiva en múltiples dermatomas, disminuyendo el riesgo de neumotórax y la toxicidad anestésica local.

Palabras clave:
Manejo del dolor
Dolor agudo
Nervios intercostales
Anestésico local
Pared torácica

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