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At least 685 records · Page 38Linked to original sources
PubMed1983

Intercostal and abdominal muscle afferent influence on pneumotaxic center respiratory neurons.

The experiments were performed on mid-collicular decerebrated, vagotomized, paralyzed, artificially ventilated cats. Phrenic (PA) and pneumotaxic center (PC) respiratory neuron (extracellular) activities were recorded during electrical stimulation of intercostal nerve proprioceptor afferents (external, internal or lateral intercostal nerves). Intercostal nerve stimulation (INS) of sufficient intensity to reduce PA also reduced the activity of phasic PC I-neurons and the I-modulated portion of tonic firing I-neurons. The stimulus-response latency for the reduction in PA was always shorter than the latency for the reduction in I-neuron activity. Baseline tonic activity (during E-phase) was unaffected by INS in most tonic I-neurons. The predominant response of PC IE- and E-neurons to INS was augmentation of their activity. Stimulus-response latency studies showed that the increase in IE- and E-neuron activity occurred after the decrease in PA. It is concluded that: (1) the reduced PC I-neuron activity following INS is due primarily to disfacilitation resulting probably from decreased activity in medullary I-neurons that drive the PC I-neurons, (2) PC IE- and E-neurons are not the primary neurons mediating the inspiratory inhibitory effects of intercostal and abdominal muscle proprioceptors on medullary I drive, (3) the changes in PC IE- and E-neuron activity is not due secondarily to changes in DRG and VRG IE- or E-neuron activities, and (4) the reflex effects are due to stimulation of low threshold Group I afferent fibers.

Abdomen↗
PubMed2005

Thoracic epidural versus intercostal nerve catheter plus patient-controlled analgesia: a randomized study.

BACKGROUND: Pain control is an important issue after thoracotomy. Ideal methods should have a high success rate, with easy implementation and minimal complications. Debate exists over the optimal pain control method. This randomized trial was designed to compare epidural (EPI) and intercostal nerve catheter with patient-controlled analgesia (ICN-PCA) for pain control after thoracotomy. METHODS: The study included 124 randomized patients; 91 had sufficient data for analysis (44 EPI, 47 ICN-PCA). The primary endpoint was pain measurement using a composite of a visual analogue scale, numerical rating, and categorical rating. A second endpoint was the success rate of each method. Pulmonary function tests, antibiotics, intensive care unit (ICU), and hospital days, and use of nonprotocol pain medications were also compared. RESULTS: There were 12 pain observations per patient (90% completed on days 1 to 5). The pain composite revealed an average postoperative pain score of 2.4 on a scale from 0 (no pain) to 10 (worst pain). There was no difference between the groups. Failures of the planned method of analgesia included 9 in the EPI group and 4 in the ICN group (p = 0.23). Another 20 patients were excluded (no difference between groups) due to unsuspected mediastinal metastases precluding thoracotomy (n = 13), and other miscellaneous factors precluding follow-up (n = 7). The EPI group had an increased number of urinary catheter days (2.5 days vs 1.7, p = 0.002) and increased narcotic supplements (p = 0.03) compared with ICN. Mean ICU days (0.9) and hospital days (6.2) were similar for both groups, and there were no differences in arrhythmias, pneumonias, transfusions, and antibiotic use. Significant differences were seen (p = 0.001) between preoperative and postoperative pulmonary function tests in both groups. However, there were no differences in pulmonary function when the groups were compared with each other. CONCLUSIONS: Satisfactory pain control was achieved after thoracotomy using either EPI or ICN-PCA. The ICN-PCA achieved equivalent pain control compared with EPI, and was placed by the surgeon with no delays in surgery, and demonstrated a decreased requirement for Foley catheter duration.

Adult↗
PubMed1988

Continuous intercostal nerve block for pain relief after thoracotomy.

Others have demonstrated the effectiveness of intercostal analgesia with bupivacaine hydrochloride (Marcain Plain; Astra). We present a greatly simplified method of effecting this. Our method is dependent on an intact pleura. To date, we have utilized this technique in 81 patients. Seventy-five (92.6%) required no additional analgesic in the first 24 hours following operation and 66 (81.5%), in the subsequent four days. Only 2 patients had postoperative pulmonary complications. No complication related either to the procedure or to the infusion of bupivacaine occurred. The technique as described here is a safe and reliable method of providing analgesia without any side effects after thoracotomy.

Adult↗
PubMed1979

Continuous intercostal nerve block for pain relief after lumbar incision.

To relieve postoperative pain along a lumbar incision in 9 patients the intercostal nerves were blocked with catheters for continuous epidural anesthesia. The catheters were inserted near the intercostal nerves, above and beneath the incision, just before the wound was closed and 0.25% bupivacaine hydrochloride solution was infused periodically through the catheters. With this technique 5 of 9 patients had a satisfactory analgesic effect and could breathe deeply or cough without pain. The other 4 patients did not have satisfactory results and this was believed to be owing to inadequate insertion of the catheters. None of the patients had any complications. The technique is simple and can produce an analgesic effect repeatedly without causing pain for the patient.

Humans↗
PubMed1977

Intercostal nerve block with flank incision.

We studied the postoperative course of 20 consecutive patients with T10 to 12 flank incisions, half of whom had intraoperative bupivacaine intercostal nerve blocks. The nerve block patients required less pain medication (p less than 0.001), ambulated 3 days earlier (p less than 0.001) and took a regular diet 2 days sooner (p less than 0.01) than the control patients.

Abdomen↗
PubMed2000

Nerve lesions about the shoulder.

The shoulder is the most mobile joint in the body. Because it serves as a way station for the nerves supplying the upper limb, it creates a potential for nerve lesions that may be caused or significantly influenced by the complex dynamics of the shoulder girdle. This article presents the most commonly encountered lesions as well as an algorithm for their diagnosis and treatment.

Accessory Nerve Diseases↗
PubMed1983

Continuous intercostal nerve blockade for pain relief following cholecystectomy.

Continuous intercostal nerve blockade was used to provide analgesia after cholecystectomy. The blockade was maintained by the insertion of a single extradural catheter into an appropriate intercostal space and by "topping-up" with local anaesthetic on demand. Of the patients studied, 92%, and 76%, required no additional analgesia in the first 24 h and first 48 h following operation, respectively. Measurements of peak flow were obtained on the 1st day after operation. A mean improvement of 37% on pre- "top-up" peak flows, was found. It is suggested that continuous intercostal analgesia is a a safe, reliable and powerful form of analgesia which may improve respiratory function after cholecystectomy.

Adolescent↗
PubMed1988

Preoperative intercostal nerve block: effect on the endocrine metabolic response to surgery.

The plasma cortisol and glucose responses to cholecystectomy were studied in 20 healthy patients. Ten patients received preoperative intercostal nerve blocks of the 6th to 12th nerves bilaterally using 0.5% bupivacaine with adrenaline 250 micrograms. The control group had the same quantity of adrenaline infiltrated into the intercostal space. Both groups had general anaesthesia with endotracheal intubation and controlled ventilation. In the non-blocked group, the mean cortisol concentration increased from a control value of 182.5 nmol litre-1 to a peak of 686.2 nmol litre-1 at 5.5 h after incision. In the blocked group the baseline serum cortisol concentration was 283.8 nmol litre-1 and it increased to a similar peak at 5.5 h. There were no significant differences between groups. The baseline plasma glucose concentration was also higher in the blocked group (4.45 mmol litre-1 compared with 3.94 mmol litre-1), but after a brief increase following the performance of the block decreased to only 14% above control values. The unblocked group exhibited substantial increase following the start of the surgery which continued for the duration of the study period to end at a mean of 6.48 mmol litre-1. These differences were significant (P less than 0.001). It is concluded that bilateral intercostal blocks may inhibit the glucose response to surgery, but have no effect on the cortisol response.

Anesthesia, General↗
PubMed2004

MR imaging of brachial plexus.

The brachial plexus is a complex anatomic component originating from ventral rami of the lower cervical nerve roots from C5 to C8 and upper thoracic spinal nerve roots from T1, providing sensory and motor innervation to the upper extremities. As it is inaccessible to palpation, clinical evaluation of the brachial plexus is very challenging and localizing lesions along its course is very difficult. The gamut of pathologic conditions involving the brachial plexus includes primary tumor, direct extension of adjacent tumor, metastasis, trauma, or an inflammatory condition. MR imaging provides superior diagnostic ability due to its ability of multiplanar imaging and greater soft tissue contrast. This article discusses MR imaging findings in a variety of pathologic conditions, with special emphasis on neoplastic process.

Brachial Plexus↗
PubMed1984

Intercostal nerve block by jet injection.

A jet injector was used to perform intercostal nerve block as a method of intra-operative and postoperative pain relief at cholecystectomy, using a concentrated solution of local analgesic. This method was shown to be as successful as the conventional needle technique. The risk of pneumothorax, and the problems of the local analgesic solution used are discussed.

Adult↗
PubMed1987

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.

Child↗
PubMed1990

Electrical control of gastric emptying in denervated and reinnervated canine stomach: a pilot study.

Gastric emptying of solids is abnormally slow after vagotomy. To determine whether it was possible to accelerate emptying by electrical stimulation either of the gastric wall directly or of a "foreign" nerve brought in to reinnervate the stomach, eight dogs underwent truncal vagotomy (TV); five of the dogs received intercostal nerve muscle pedicle (NMP) implants. Gastric atony was demonstrated postoperatively in all animals up to 4 months later by means of radiological contrast studies. After allowing time for neurotization to occur (mean 78 days), the cervical vagi were stimulated to confirm that TV was complete. Gastric peristalsis, intraluminal pressures, and emptying were assessed during stimulation of the NMPs and of the gastric wall, followed by sacrifice for histologic study. Neither reinnervation alone nor stimulation of the NMPs improved emptying. Although viable somatic nerve was found in the gastric wall, nerve sprouting was not. By contrast, stimulation of the gastric wall with trains of pulses (20 Hz, 2-10 ms, 2-5 mA) evoked peristalsis in all animals. We conclude that somatic nerve tissue cannot produce functional reinnervation of a visceral organ; however, direct muscular stimulation can accelerate gastric emptying after TV.

Abdominal Muscles↗