1-3 Due to the several reports known about the underlying cause of the chronic post thoracotomy pain, intercostal nerve
damage has been suggested to be the most common reason.
We prospectively evaluated the effect of clonidine as an adjuvant to bupivacaine for continuous paravertebral intercostal nerve
block, measuring pain and sedation scores and pulmonary function tests.
Zhang commonly reroutes one of the intercostal nerves
that lead from the spinal cord around each rib to the sternum, If the intercostal nerve
is not long enough to reach the target nerve site below the injury level, a segment of the sural nerve (isolated from the calf) is attached to the intercostal nerve
blocks, Thoracic epidural, Opioids in the epidural space, and transcutaneous electrical nerve stimulation, can produce adequate analgesia but have their limitations along with possible side effects.
In paravertebral block the anaesthetic agent is delivered to most logical space through which runs the intercostal nerve
as it exits intervertebral foramina, its dorsal primary ramus (supplying posterior spinal muscles and costovertebral ligament strained at thoracotomy), its collateral branch (supplying the parietal pleura) and the sympathetic afferents on that side (supplying the visceral pleura).
He then proceeded to isolate an intercostal nerve
from Yang's rib region, maintaining the nerve's connection to the spinal cord.
Sensory nerve supply is from second to fourth intercostal nerve
. Dominant pedicle of flap is largely based on first, second and perforating branches of internal mammary artery.
INTRODUCTION: Normally the undivided lateral cutaneous branch of second intercostal nerve
leaves the second intercostal space by piercing the lateral thoracic wall at midaxillary plane, passes along the base of axilla within the central group of axillary lymph nodes, reaches the upper and medial part of arm where it joins with medial cutaneous nerve of arm to form intercostobrachial nerve to supply the skin of upper and medial parts of arm.
block was given by the surgeon at the end of surgery for post operative analgesia and later on maintained with drugs like fentanyl, tramadol and paracetomol IV.
The sympathetic chain lies in the same fascial plane, just anterior to the intercostal nerve
and communicates with it via the rami communicants
However, it was not possible to identify the origin of the innervation of the upper fascicle, which if it was by neighborhood, it could be given by a muscular branch from the intercostal nerves
. Functionally, the dorsoepicondylar medial muscle could act as a weak adductor of the arm given its insertion points and the direction of its muscular fibers.