Upper limb sympathetic blockade following intercostal nerve blocks

A case of transient sympathetic block of the arm following percutaneous intercostal nerve injections is described and the possible aetiology discussed.

Intercostal catheterisation. An alternative approach to the paravertebral space

Twenty-one patients scheduled to undergo thoracotomy or median sternotomy had intercostal catheters inserted pre-operatively. During thoracotomy, under direct vision, the spread of 20 ml of a solution containing bupivacaine and methylene blue was followed. In most cases the spread involved one or two intercostal spaces. However, in all but one patient, dye spread medially to the paravertebral space where it then spread in both caudad and cephalad directions to reach between two and five vertebrae. In three cases, dye was seen crossing the anterior surface of the vertebrae to reach the contralateral aspect. It is concluded that a major component of dermatomal block during intercostal catheterisations may be secondary to paravertebral spread.

Intercostal nerve blockade for children

A modified technique of intercostal nerve blockade is described which is suitable for use in children. Ten patients received intercostal nerve blockade on a total of 29 occasions in order to provide analgesia following liver transplantation and to facilitate weaning from artificial ventilation of the lungs. The opioid requirement of patients who received intercostal nerve blockade was considerably lower than that of those who did not; 56% of the children who received intercostal nerve blockade required no additional analgesia. One child, the first to receive intercostal nerve blockade, developed a pneumothorax following the procedure. The technique has proved to be safe in skilled hands. It is an acceptable method of postoperative analgesia in children after liver transplantation and may be a useful technique in the management of other paediatric patients.

Postoperative paravertebral blocks for thoracic surgery. A radiological appraisal

Five patients who underwent thoracic operations had an extradural catheter placed in the paravertebral space. X-ray contrast was injected through the catheters. In those who had detectable analgesia, contrast spread extensively, laterally, along one intercostal space, and up and down the paravertebral spaces. In one patient, contrast appears to have entered the extradural space and, in another who had no detectable analgesia, the contrast was probably dispersed intrapleurally. The significance of these findings is discussed.

Radiographic study of intercostal nerve blockade in healthy volunteers

The spread of solutions injected to the intercostal space was studied in 10 healthy volunteers. Up to 20 ml of a 50:50 mixture of local anaesthetic solution and a radiopaque dye was injected through a modified extradural catheter placed in an intercostal space at the posterior angle of the rib. Radiographic films demonstrated spread by an extrapleural route into adjacent intercostal spaces and this was confirmed by the occurrence of analgesia in the corresponding dermatomes. The relevance of these results to clinical practice is discussed.

Continuous intercostal blockade after cardiac surgery

The provision of analgesia using continuous bilateral intercostal blockade was compared with that provided by conventional i.v. narcotics for the first 48 h after cardiac surgery. The subjective quality of analgesia was significantly superior with the regional technique. However, pulmonary function tests, gas exchange, lung volume, and radiological and clinical evidence of pulmonary complications were not improved. The failure to reduce morbidity and the potential for complications such as pneumothorax, makes it difficult to recommend the regional analgesia technique in this situation.

Intercostal neuralgia following stellate ganglion block. An infrequent complication

The case is described of a 78-year-old female patient who experienced temporary but severe chest wall pain following stellate ganglion block. The possible mechanisms and treatment of this complication are discussed.

Intrathoracic intercostal nerve block with phenol in open chest surgery. A randomized study with statistical evaluation of respiratory parameters

Seventy-three patients who underwent thoracic surgery were randomly selected for intraoperative intercostal nerve block using phenol (32 block and 41 control subjects). The patients were divided into three groups: pneumonectomies, lobectomies and explorative thoracotomies and evaluated by pain level, respiratory function parameters (VT, IRV, ERV, VC) and blood-gas analysis, both six and 24 hrs after surgery. The patients who had intraoperative nerve block using phenol enjoyed a more comfortable postoperative period. In particular, respiratory parameters were statistically better.

The rectus abdominis syndrome: a case report

The case is reported of a patient with a rectus abdominis syndrome. Attention is drawn to the possibility that patients with abdominal pain, in whom no intra-abdominal cause is found, may suffer from this presumed nerve entrapment syndrome. No surgery is required and therapy can be simple.

[Syndrome of perforating lateral branches of the subcostal and ilio-hypogastric nerves. An unrecognized cause of hip pain]

The authors report 10 cases of pain in the outer surface of the hip related to damage of the perforating lateral branch of the subcostal or ilio-hypogastric nerve, which innervate this region. Anatomic investigation showed that there was a possibility of canal neuropathy, the possible mechanisms and signs of which are discussed. In general, treatment consisted of local infiltrations, but one patient underwent surgery with highly successful results.