intercostal nerve block....

Intercostal nerve block is an effective technique to provide postoperative analgesia without central respiratory depression and to attenuate the decrease in pulmonary function after thoracic surgery.

Postthoracotomy pain is not completely managed with intercostal analgesia; it requires supplemental use
of parenteral opioids or NSAIDs.

Intercostal nerve block can be performed intraoperatively by intrathoracic injection or percutaneously by the anesthesiologist.

Nerve blocks are performed at the levels above and below the site of chest tube insertion and incision.

Nerve blocks are performed by injection of 2–3 mL of bupivacaine 0.5% with epinephrine (1:200,000 concentration).

Because the average duration of these nerve blocks is 4–8 hours, placement of indwelling catheters in the intercostal space is used to provide analgesia up to 6 days

Complications of this technique are few but include pneumothorax, local anesthetic toxicity, and neuroaxonal spread of local anesthetics that can result in unintentional hypotension.

Sabanathan S, Mearns AJ, Bickford Smith PJ, et al. Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics. Br J Surg 1990;77:221–225.

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

Br J Anaesth 1975;47(Suppl):284–286.

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