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PubMed1975

Intercostal nerve blockade for evaluation of local anaesthetic agents.

Bilateral intercostal nerve block provides the opportunity to subject as many as 16 separate peripheral nerves in a single subject to known or unknown local anaesthetic agents in a variety of concentrations, volumes, and additives. It permits the observation of local (e.g., neuritis), clinical (e.g., onset and duration), and systemic (e.g., toxicity and blood concentration) effects of these variables. In double-blind studies, bilateral intercostal nerve block allows the use of each side of the trunk for comparison of two experimental drugs, a new drug against a standard, or two new drugs. Subtle differences in clinical properties as well as simultaneous blood concentrations may be detected in these studies. The advantages of this technique in evaluating local anaesthetic agents are primarily the use of a single subject as his own control while studying may separate peripheral nerves. This aids appreciably in limiting the variable of age, temperature, and perfusion, as well as techniques of administration and evaluation. The constancy of the anatomy of the intercostal nerve provides a highly reliable and reproducible block technique.

Abdomen↗
PubMed1990

Phrenic nerve pacing of the quadriplegic patient.

Phrenic nerve pacing can be used to free a quadriplegic patient from ventilatory dependency. During a 6-year period (1982 to 1988), 23 patients with an age range of 17 to 63 years (mean 31 years) underwent implantation of a phrenic nerve pacemaker because of ventilatory dependency resulting from quadriplegia. Fourteen patients had a unilateral phrenic nerve implant and nine had a bilateral implant. The time from injury to implantation was 12 to 16 weeks. The site of implantation was the cervical phrenic nerve in 13 patients and the thoracic phrenic nerve in 10 patients. During the past 24 months, only a transthoracic approach has been used. The indication for pacing was failure to be weaned from ventilatory support in all patients. Failure to stimulate the phrenic nerve at implantation was noted in three patients, despite preoperative testing indicating an acceptable response. There were no deaths, and minor complications developed in three patients. Follow-up is available in all patients: Eight patients are completely free from the ventilator; nine patients are in markedly improved condition but require the ventilator at night; three patients are in moderately improved condition; and three patients had no response. Three patients required reexploration for component failure from 6 weeks to 18 months after implantation.

Adult↗
PubMed1986

[Changes in the activity of phrenic motor neurons in response to reduced compliance of the abdominal wall (apropos of the significance of the excitatory intercostal-phrenic reflex)].

A pressure on the abdomen by pneumatic cuff was performed in 13 decerebrated vagotomized cats for enhancing the excitatory intercostal-to-phrenic reflex. "Moving averages" of the electrograms of the phrenic nerve and oblique abdominal muscles, as well as abdominal cavity pressure were recorded. In these conditions the changes of the phrenic activity were weak and inconsistent. Significant changes of the peak amplitude of phrenic ENG were absent. In the majority of the experiments diminutions of the respiratory cycles, inspiratory and expiratory durations (up to 6%), as well as enhancing of the rate of rise of phrenic activity (up to 5-7%) took place. The latter can be a manifestation of the intercostal-to-phrenic reflex. This reflex in breathing may have but a weak influence on the phrenic motoneurons excitation.

Abdominal Muscles↗
PubMed1985

The human musculus obliquus externus abdominis innervated by ramus muscularis externus of intercostal nerves.

Each of the uppermost slips of the bilateral M. obliquus externus abdominis originated from the fifth rib and was innervated from its inner surface by the Ramus muscularis externus of the fifth intercostal nerve, in one corpse. Furthermore, the slip originating from the sixth rib of the right M. obliquus externus abdominis was innervated not only by the lateral cutaneous branches of the sixth and seventh intercostal nerves from its outer surface, but also by the Ramus muscularis externus of the sixth intercostal nerve from its inner surface. The slip originating from the fifth rib was given us an aspect in appearance as if it were the uppermost slip of origin of this muscle, but its true nature is considered to be the M. obliquus abdominis externus profundus from the viewpoint of its innervating nerve and pattern. In addition, the slip originating from the sixth rib is considered to be a substance formed by the dorsal adhesion of the M. obliquus abdominis externus profundus originating from the sixth rib to the slip of the M. obliquus externus abdominis originating from the same rib.

Abdominal Muscles↗