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At least 19 recordsLinked to original sources
PubMed1992

[A study on the communication between the pectoral nerve and the extramural nerve branches of the intercostal nerves].

Kumaki et al. (1979) defined the extramural nerve as the rudimentary sensory nerve which appeared on the upper thoracic wall; it branched off the root of the lateral cutaneous nerve of the second, third or fourth intercostal nerve, ran inferomedially adhering to the fascia of the intercostalis externus muscle and ended supplying the membrane covering the adjacent rib. They also stated that the extramural nerve (Rxm) occasionally became a cutaneous nerve which pierced the pectoralis muscles and supplied the skin covering the thoracic wall similar to the lateral cutaneous nerve (Rcl) or the anterior cutaneous nerve (Rca). Further, they proposed that the muscular nerves to the obliquus externus abdominis muscle which are usually situated below the fifth rib might be considered a part of this Rxm series. Although the definition of Rxm is still not widely accepted, Rxm is thought to be a key morphological factor influencing the variations of peripheral nerve arrangement on the thoracic wall. In the student course of gross anatomy dissection at Iwate Medical University School of Medicine during the years 1987-1991, three cases of Rxm communicating with the pectoral nerve and supplying the pectoralis major muscle were observed. Some cases have been reported in which Rcl innervates part of the pectoral muscles. However, the communication between the pectoral nerve and Rxm has not yet been discussed. Therefore, to clarify the morphological significance of the communication between Rxm and the pectoral nerve, the branching pattern and the distribution of the pectoral nerves were extensively investigated and the intramuscular nerve supply of some pectoral nerves, especially the pectoral nerves which communicated with Rxm, was examined in detail under a stereomicroscope. The results are summarized as follows: 1. In the first case, Rxm of the second intercostal nerve originated from Rcl, ran inferomedially adhering to the fascia of the intercostalis externus muscle and pierced the origin of the pectoralis minor muscle at the third intercostal space. Then Rxm turned superolaterally to communicate with a pectoral nerve which originated from the loop composed of the lateral and medial pectoral nerves and passed inferior to the pectoralis minor muscle. After communication, the pectoral nerve with Rxm supplied the caudalmost part of the sternocostal portion of the pectoralis major muscle. In the second case, a similar branch of Rxm of the second intercostal nerve passed inferior to the pectoralis minor muscle.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
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↗
PubMed1979

[The distribution of sensory and motor axons of the intercostal nerves and their branches (author's transl)].

As it is well established that motor axons in general display a higher acetylcholinesterase-activity than sensory axons do, the histochemical method of KARNOVSKY and ROOTS (1964) was used for the differentiation of motor and sensory fibres in the intercostal nerves and their branches. In the paravertebral sections of the intercostal nerves of the upper segments 30--35% of the nerve fibres show a high enzyme activity and therefore were classified as motoric. The percentage of the motor fibres in comparable zones of the lower segments increases to 45%. Only 15% of the nerve fibres proved to be motoric in the parasternal sections of the intercostal nerves. In a histogram of the acetylcholinesterase-positive intercostal nerve fibres 2 peaks can be seen: one in the alpha-calibre class, the second in the gamma-class. There are more motor axons in the lateral cutaneous branch of the lower intercostal nerve than in upper ones. This may be explained by the participation of these nerve branches in the innervation of the abdominal muscles. In 2 cases nerve branches of the intercostal nerve to the diaphragm were found containing 15--25% motor axons.

Acetylcholinesterase↗
PubMed1992

Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients.

Intercostal nerve transfer is a well-established and effective technique for irreparable avulsed brachial plexus injuries. Between 1987 and 1989, 66 patients with brachial plexus injuries were treated by means of intercostal nerve transfer to the musculocutaneous nerve, with or without nerve grafts to obtain elbow flexion. The results were evaluated. Five clinical signs--(1) induction of chest pain by squeezing of biceps, (2) proximal biceps contraction, (3) distal biceps contraction, (4) active elbow flexion against gravity, and (5) active elbow flexion against weight--were identified and used as a guide for functional recovery. The overall success rate with motor function of grade 4 or more was 67%. The motor results were better in 1989 (81%) because of greater familiarity with the anatomy and improved surgical technique. The important factors in obtaining a good result are (1) early exploration (less than 5 months after trauma), (2) use of three intercostal nerves, (3) mixed nerve-to-mixed nerve coaptation, (4) nerve repair without grafts and under no tension, and (5) shoulder stability.

Adolescent↗
PubMed1979

Postnatal maturation of phrenic, vagus, and intercostal nerves in the kitten.

In the present work, we have compared the histological maturation of the phrenic nerve, the internal and external intercostal nerves of the 8th space and the vagus nerve. At least three nerves from each category have been taken from different kittens each week during the first 2 months of postnatal life, and each month for kittens aged between 2 and 8 months. Compared to references obtained in the adult animal, the development of the number and diameter of myelinated fibers has been studied for each nerve. Moreover, the maturation of unmyelinated fibers of the phrenic nerve has been studied with the electrom microscope. There is a possibility of a cephalo-caudal maturation in the somatic nerves. Important differences exist between somatic nerve maturation and that of the vagus nerve.

Animals↗
PubMed1976

Total spinal anesthesia: a rare complication of intrathoracic intercostal nerve block.

Total spinal anesthesia following intrathoracic intercostal nerve blocks with bupivacaine performed for postoperative pain relief during thoracotomy is described. Possible mechanisms for this complication include: (1) inadvertent placement of the needle through an intervertebral foramen, (2) puncture of a long dural cuff, and (3) intraneural injection with central spread. Recognition of this potential complication is important, and facilities for proper support must be available.

Bupivacaine↗
PubMed1992

Continuous extrapleural intercostal nerve block and post-thoracotomy pulmonary complications.

To evaluate the effects of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary complications, a randomized, double-blind, placebo-controlled study was conducted on 80 patients undergoing elective thoracotomy for pulmonary (n = 47) or oesophageal (n = 33) procedures. In patients who received continuous bupivacaine infusion, the requirement for intramuscular opiate and rectal diclofenac was less, the score on a visual linear analogue pain scale lower and recovery of pulmonary function more rapid than in saline-infused controls. Postoperative pulmonary complications occurred in 35% of the saline group, but only 10% of the patients with bupivacaine infusion (p < 0.01). In patients with chronic obstructive airways disease (COAD), the incidence of postoperative pulmonary complications was 54.5% in the saline group and only 4.5% in the bupivacaine group (p < 0.01). Among the patients without COAD there was no significant intergroup difference in such complications. We conclude that continuous extrapleural intercostal nerve block is effective for post-thoracotomy analgesia and reduces pulmonary complications of thoracotomy in patients with COAD.

Analgesia↗
PubMed1975

Etidocaine in intercostal nerve block for pain relief after thoracotomy; a comparison with bupivacaine.

For pain relief after thoracotomy, intercostal nerve block with etidocaine 1% and bupivacaine 0.5%, both containing adrenaline 5 mug/ml, was used. Duration of skin analgesia for sharp pain was around 11 hours for both solutions. Post-operative pain was noted 6 and 5 hours after injection for etidocaine and bupivacaine respectively. No pathological changes in acid-base balance or ventilation were observed. Peak expiratory flow decreased to 35-40% of the pre-operative values and remained at this level for about 12 hours. Arterial and venous blood levels of the local anaesthetics were low and no signs of toxicity were noted. All patients experienced a certain pain relief from the blocks. Because of shoulder pain in some patients intercostal nerve block alone does not seem to be a perfect post-operative method for pain relief after thoracotomies.

Acetanilides↗
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↗
PubMedDate not supplied

Intercostal nerve transfer to lumbar nerve roots. Part II: Neuropathologic findings in the animal model.

These are the neuropathologic findings in dogs 8-11 months after a unilateral intercostal nerve transfer and anastomosis to a lumbar nerve root were performed. This is a follow-up study of a procedure that was initially carried out in the adult and infant human cadaver and subsequently in an animal model by Malik and Buhr, as reported in this issue of Spine. At the time of sacrifice, the animals in this study had lost the limp that they had postoperatively. The results demonstrate the viability of the intercostal nerve transfer and its anastomosis to the lumbar motor root. There was supplied by a lumbar nerve root that had been operated upon, but the basis of this was not definitely established.

Animals↗
PubMed1977

Kindness pays dividends: the medical benefits of intercostal nerve block following thoracotomy.

Postoperative pain is an important factor in the management of children undergoing thoracotomy. Intercostal nerve block has been used in adult patients, but its applicability in the pediatric age group has not been previously evaluated. Eighty-nine children (85 girls and 31 boys) aged 6 months to 16 years (mean age 4.7 years) underwent ligation of a patent ductus arteriosus (PDA) through a left thoracotomy. Twenty-nine children received intercostal blocks with bupivacaine from the level of the second to sixth thoracic vertebrae. Sixty cases constituted the control group. The patients with intercostal block had fewer doses of pain medication postoperatively, 2.7 mean (0 to 9), than did the control patients, 3.9 mean (0 to 21). The mean hospital stay was shortened in the patients with nerve block, 5.1 days versus 7.3 days for the control group. No ill effects of bupivacaine were noted. We conclude that intercostal nerve block is a valuable procedure reducing the need for postoperative analgesia and shortening hospital stay.

Adolescent↗
PubMed1976

Arterial and venous plasma levels of bupivacaine following epidural and intercostal nerve blocks.

Arterial and peripheral venous plasma levels of bupivacaine were determined in 30 patients following epidural anesthesia using 150 and 225 mg, as well as following intercostal nerve block with 400 mg. Arterial levels were consistently higher than levels in simultaneously sampled venous blood, and the highest levels occurred with bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine may have a wider margin of safety in man than is now stated.

Adult↗
PubMed1975

Intercostal nerve block for postoperative somatic pain following surgery of thorax and upper abdomen.

From 1948 to 1973, intercostal nerve block was used 10,941 times or a total of approximately 100,000 individual nerves were blocked. Junior staff (residents) performed 95% of the blocks. The local anaesthetic solution of choice used 0.25 or 0.5% bupivacaine (Marcaine) with adrenaline. Total milligram doses of bupivacaine as high as 400 mg were employed. The duration of the blocks was 9-18 hr. No severe systemic toxic reactions occurred, e.g. disorientation, convulsions, etc. The incidence of pneumothorax was 0.073%.

Abdomen↗
PubMed1975

Effect of intercostal nerve blockade during operation on lung function and the relief of pain following thoracotomy.

The use, during operation, of intercostal nerve blocks with lignocaine and bupivacaine for the relief of pain following thoracotomy was assessed in 138 patients. Irrespective of the method used to evaluate efficacy, it was not possible to demonstrate a lasting effect of clinical significance favouring either local anaesthetic agent. This form of treatment, although free from serious side effects, had no beneficial effects on lung function and is not recommended for the relief of pain following surgery.

Blood Pressure↗
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↗
PubMed1977

Effects of intercostal nerve blocks (bupivacaine 0.25% and etidocaine 0.5%) on chest wall mechanics in healthy men.

Bilateral blockade of the 5th to 11th intercostal nerves, inclusive, was produced in 14 healthy subjects. In seven, bupivacaine 0.25% was used, and in the other seven, etidocaine 0.5%. The latter has been found to have a stronger motor-blocking action than the former. Before and after the blockade, the vital capacity (VC), peak expiratory flow rate (PEF), tidal volumes, respiratory variations in rib cage and abdominal circumferences and in oesophageal and intragastric pressures were recorded. By transthoracic electrical impedance pneumography, measures indicating changes in the functional residual capacity (FRC) were obtained. Although it was considered that changes in the parameters investigated mainly demonstrated changes in motor function, no differences were found between the drugs. With this form of blockade they seem to have equivalent effects in this respect. Thus, VC decreased by an average of 7% and PEF by 6%. Signs of a reduction of FRC after the blockade were also observed. The blockade had no effect on the partitioning of costal and abdominal breathing at rest. Analysis of the relations between the fractions of costal and abdominal breathing and the corresponding variations in intragastric pressure gave support to the view that in normal individuals both intercostal and abdominal muscles remain passive during respiration at rest. This is thus achieved by the diaphragm alone.

Acetanilides↗