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At least 523 records · Page 29Linked to original sources
PubMed1980

A technique for continuous intercostal nerve block analgesia following thoracotomy.

Early after thoractomy, incisional chest pain may lead to a sequence of undersirable effects on respiratory function, in addition to causing patient discomfort. Pharmacologic blockade of the intercostal nerves innervating the incisional area can improve respiratory function as well as patient comfort. The postoperative production of continuous intercostal nerve blockade can be accomplished by the insertion of indwelling analgesic catheters at the time of thoracotomy closure.

Bupivacaine↗
PubMed1994

Bilateral thoracoscopic lower sympathetic-splanchnicectomy for upper abdominal cancer pain.

Upper abdominal pain secondary to cancer may cause great disability to patients. Surgical sympathetic-splanchnicectomy, or coeliac plexus block, has been used to relieve intractable upper abdominal cancer pain from stomach, liver, gallbladder or pancreas for a long time. There are, however, intrinsic disadvantages when performing these procedures. Due to our long experience of therapeutic thoracoscopy, we recently performed bilateral thoracoscopic sympathetic-splanchnicectomy on 14 patients (eight male and six female) for relief of pain from primary or metastatic upper abdominal cancers. Most of them were satisfied with the immediate pain relief after the operation. In this new era of therapeutic endoscopy, endoscopic surgery will gradually take the place of open methods in treatment of many diseases. It can be anticipated that thoracoscopic lower sympathetic-splanchnicectomy is undoubtedly a good alternative method for management of intractable upper abdominal pain.

Abdominal Pain↗
PubMed1977

[High spinal anaesthesia following intrathoracic intercostal nerve block. Report of a case (author's transl)].

In a 59-year-old female, anaesthetized with halothane, nitrous oxide/oxygen, intercostal nerve blocks were performed after right lateral thoracotomy. Before closure of the chest four segments were blocked each with 3 ml 0.5% bupivacain (Marcain, Carbostesin) without adrenaline. Three minutes after the last injection, the blood pressure, heart rate, and central venous pressure fell. The postoperative neurological status showed a high spinal anaesthesia. The patient was able to be extubated 90' after the last block and there were no further complications. The possible mechanism of producing spinal anaesthesia after peripheral nerve blocks and the necessary precautions to avoid this complication are discussed.

Anesthesia, Spinal↗
PubMed2001

Thoracic origin of a sympathetic supply to the upper limb: the 'nerve of Kuntz' revisited.

An understanding of the origin of the sympathetic innervation of the upper limb is important in surgical sympathectomy procedures. An inconstant intrathoracic ramus which joined the 2nd intercostal nerve to the ventral ramus of the 1st thoracic nerve, proximal to the point where the latter gave a large branch to the brachial plexus, has become known as the 'nerve of Kuntz' (Kuntz, 1927). Subsequently a variety of sympathetic interneuronal connections down to the 5th intercostal space were reported and also described as the nerve of Kuntz. The aim of this study was to determine: (1) the incidence, location and course of the nerve of Kuntz; (2) the relationship of the nerve of Kuntz to the 2nd thoracic ganglion; (3) the variations of the nerve of Kuntz in the absence of a stellate ganglion; (4) to compare the original intrathoracic ramus with sympathetic variations at other intercostal levels; and (5) to devise an appropriate anatomical classification of the nerves of Kuntz. Bilateral microdissection of the sympathetic chain and somatic nerves of the upper 5 intercostal spaces was undertaken in 32 fetuses (gestational age, 18 wk to full term) and 18 adult cadavers. The total sample size comprised 99 sides. Sympathetic contributions to the first thoracic nerve were found in 60 of 99 sides (left 32, right 28). Of these, 46 were confined to the 1st intercostal space only. The nerve of Kuntz (the original intrathoracic ramus) of the 1st intercostal space had a demonstrable sympathetic connection in 34 cases, and an absence of macroscopic sympathetic connections in 12. In the remaining intercostal spaces, intrathoracic rami uniting intercostal nerves were not observed. Additional sympathetic contributions (exclusive of rami communicantes) were noted between ganglia, interganglionic segments and intercostal nerves as additional rami communicantes. The eponym nerve of Kuntz should be restricted to descriptions of the intrathoracic ramus of the 1st intercostal space. Any of these variant sympathetic pathways may be responsible for the recurrence of symptoms after sympathectomy surgery.

Adult↗
PubMed1992

Ability of each lumbar splanchnic nerve and disability of thoracic ones to generate seminal emission in the dog.

Control of seminal emission by canine thoracolumbar splanchnic nerves which constitute the caudal mesenteric plexus (inferior mesenteric and superior hypogastric plexuses in human) was investigated. Electrical stimulation of a splanchnic nerve group which branched from sympathetic trunks at thoracic and L1 ganglia and descended on the ventral wall of the aorta between bilateral spermatic arteries via the intermesenteric plexus did not cause seminal emission in all 13 dogs examined. In contrast, electrical stimulation of the other splanchnic nerve group which branched from lumbar sympathetic trunks at ganglia L1-L5 and descended behind bilateral spermatic arteries induced seminal emission regardless of branching levels or sides. The results indicate that efferent signals via the intermesenteric plexus do not generate seminal emission, while those via each lumbar splanchnic nerve have ability to generate seminal emission in the dog.

Animals↗
PubMed1999

[Transplantation of the vascular pedicled thoracicus longus nerve for recovering sensory capacities in the mentalis nerve supply region].

In the last few years microvascular techniques have improved the morphologic and functional results of reconstructive facial surgery. A main advantage is that neuronal rehabilitation can be achieved after tumor surgery. In this study the vascularized thoracic long nerve transplant was used for neuronal reconstruction of the alveolar inferior nerve after resection during tumor surgery. Five patients were examined for recurrence of neuronal function in the mental nerve and lip region after surgery in monthly control intervals. Sensation of pressure and pain was recorded for 3 months, sensation of contact and vibration feeling for 5 months and temperature sensation for 7 months after neuronal reconstruction. Nine months after surgery the mental nerve and lip sensitivity were the same on both sides--the reconstructed and the healthy side--in four patients. Thus, the vascularized thoracic long nerve seems to be a good nerve transplant for bridging defects of the alveolar inferior nerve after resection during tumor surgery.

Aged↗