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Chest Wall Blocks and Neurolysis

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Essentials of Interventional Techniques in Managing Chronic Pain

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Abstract

Chest wall blocks are used in pain medicine to diagnose and treat acute and chronic pain conditions of the chest wall and abdomen. Patients presenting with unilateral or bilateral pain associated with a variety of neuropathic conditions are good candidates for these blocks. The blocks relieve pain involving the parietal pleura, skin, and intercostal muscles and usually do not affect or help the more deep-seated visceral painful states. While radiofrequency ablation is used more commonly for benign, chronic, continuous pain, chemical neurolysis is reserved for the terminally ill cancer pain of the chest wall primarily due to complications related to placement and spread of the neurolytic agents. Complications related to intercostal nerve blocks including the dreaded pneumothorax and vascular absorption should mandate that the technique be done either with fluoroscopic guidance or ultrasound; however, there are no good studies indicating that localization techniques prevent these complications completely.

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References

  1. Karmaker MK, Ho AMH. Acute pain management of patients with multiple fracture ribs. J Trauma. 2003;54:612–5.

    Article  Google Scholar 

  2. Osinow OA, Zahrani M, Softah A. Effect of intercostal nerve block with 0.5% bupivacaine on peak expiratory flow rate and arterial oxygen saturation in rib fractures. J Trauma. 2004;56:345–7.

    Article  Google Scholar 

  3. Kopacz DJ, Thompson GE. Intercostal blocks for thoracic and abdominal surgery. Tech Reg Anesth Pain Manage. 1998;2:25–9.

    Article  Google Scholar 

  4. Yentis SM, Vlassakov KV. Vassily von Anrep. Forgotten pioneer of regional anesthesia. Anesthesiology. 1999;90:890–5.

    Article  CAS  PubMed  Google Scholar 

  5. Vaghadia H, Jenkins LC. Use of a doppler ultrasound stethoscope for intercostal nerve block. Can J Anaesth. 1988;35:86–9.

    Article  CAS  PubMed  Google Scholar 

  6. Joshi GP, Bonnet E, Shah R, et al. A systematic review of randomized trials evaluating regional techniques for post thoracotomy analgesia. Anesth Analg. 2008;107:1026–40.

    Article  CAS  PubMed  Google Scholar 

  7. Koehler RP, Keenan RJ. Management of postthoracotomy pain: acute and chronic. Thorac Surg Clin. 2006;16:287–97.

    Article  PubMed  Google Scholar 

  8. Narchi P, Singelyn F, Paqueron X, Nicholls B. Truncal blocks. In: Benzon HT, Rathnell JP, Wu CL, Hurley RW, editors. Practical management of pain. 5th ed. Philadelphia: Elsevier Mosby; 2014. p. 749–50.

    Google Scholar 

  9. Shin DY, Lennard TA. Proximal upper extremity, trunk, and head blocks. In: Lennard TA, editor. Psychiatric procedures in clinical practice. Philadelphia: Hanley and Belfus; 1995. p. 133.

    Google Scholar 

  10. Abram SE. Neural blockade for neuropathic pain. Clin J Pain. 2000;16:S56–61.

    Article  CAS  PubMed  Google Scholar 

  11. Wong FC, Lee TW, Yuen KK, et al. Intercostal nerve blockade for cancer pain: effectiveness and selection of patients. Hong Kong Med J. 2007;13:266–70.

    PubMed  Google Scholar 

  12. Curatolo M, Eichenberger U. Ultrasound-guided blocks for the treatment of chronic pain. Tech Reg Anesth Pain Manage. 2007;11:95–102.

    Article  Google Scholar 

  13. Byas-Smith MG, Gulati A. Ultrasound-guided intercostal nerve cryoablation. Anesth Analg. 2006;103:1033–5.

    Article  PubMed  Google Scholar 

  14. Connelly NR, Malik A, Madabushi L, Gibson C. Use of ultrasound-guided cryotherapy for the management of chronic pain states. J Clin Anesth. 2013;25:634–6.

    Article  PubMed  Google Scholar 

  15. Bhalla T, Sawardekar A, Dewhirst E, et al. Ultrasound-guided trunk and core blocks in infants and children. J Anesth. 2013;27:109–23.

    Article  PubMed  Google Scholar 

  16. Oliver JA, Oliver LA. Beyond the caudal: truncal blocks an alternative option for analgesia in pediatric surgical patients. Curr Opin Anaesthesiol. 2013;26:644–51.

    Article  PubMed  Google Scholar 

  17. Shankar H, Khatri V, Eastwood D. Retrospective comparison of ultrasound and fluoroscopic image guidance for intercostal steroid injections. Pain Pract. 2010;10:312–7.

    Article  PubMed  Google Scholar 

  18. Bhatia A, Gofeld M, Ganapathy S, et al. Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers. Reg Anesth Pain Med. 2013;38:503–7.

    Article  PubMed  Google Scholar 

  19. Ozkan D, Akkaya T, Karakoyunlu N, et al. Effect of ultrasound-guided intercostal nerve block on postoperative pain after percutaneous nephrolithotomy: prospective randomized controlled study. Anaesthesist. 2013;62:988–94.

    Article  CAS  PubMed  Google Scholar 

  20. Behnke H, Geldner G, Cornelissen J, et al. Postoperative pain therapy in minimally invasive direct coronary arterial bypass surgery: I.V. Opioid patient-controlled analgesia versus intercostal block. Anaesthesist. 2002;51:175–9.

    Article  CAS  PubMed  Google Scholar 

  21. Fujiwawa A, Komasawa N, Minami T. Intercostal nerve block combined with pectoral nerve block for cardiac resynchronization therapy device implantation. Spring. 2014;3:409.

    Article  Google Scholar 

  22. Flores RA, Ortiz RA, Markan S. Multilevel continuous intercostal nerve block catheter: a viable alternative to thoracic epidural for multiple rib fractures. Anesthesiology. 2013;119:994.

    Article  PubMed  Google Scholar 

  23. Bhatia A, Brull R. Review article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes. Anesth Analg. 2013;117:236–51.

    Article  PubMed  Google Scholar 

  24. Moore DC. Anatomy of the intercostal nerve: its importance during thoracic surgery. Am J Surg. 1982;144:371–3.

    Article  CAS  PubMed  Google Scholar 

  25. Davies F, Gladstone RJ, Stibbe EP. The anatomy of the intercostal nerves. J Anat. 1932;66:323–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Rendina EA, Ciccone AM. The intercostal space. Thorac Surg Clin. 2007;17:491–501.

    Article  PubMed  Google Scholar 

  27. Graeber GM, Nazim M. The anatomy of the ribs and the sternum and their relationship to chest wall structure and function. Thorac Surg Clin. 2007;17:473–89.

    Article  PubMed  Google Scholar 

  28. Hardy PA. Anatomical variation in the position of the proximal intercostal nerve. Br J Anaesth. 1988;61:338–9.

    Article  CAS  PubMed  Google Scholar 

  29. Rozen WM, Tran TMN, Ashton MW, et al. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat. 2008;21:325–33.

    Article  CAS  PubMed  Google Scholar 

  30. Doi K, Nikai T, Sakura S, et al. Intercostal nerve block with 5% tetracaine for chronic pain syndromes. J Clin Anesth. 2002;14:39–41.

    Article  CAS  PubMed  Google Scholar 

  31. Waldman S. Intercostal nerve block. In: Atlas of interventional pain management. 4th ed. Philadelphia: Saunders; 2015. p. 336–44.

    Google Scholar 

  32. Stone JB, Marcaine K, Furman MB. Intercostal Blockade. In: Furman MB, Lee TS, Berkwits L, editors. Atlas of image-guided spinal procedures. Philadelphia: Elsevier Saunders; 2013. p. 231–5.

    Google Scholar 

  33. Waldman S. Ultrasound guided intercostal nerve block. In: Comprehensive Atlas of ultrasound guided pain management injection techniques. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 598–605.

    Google Scholar 

  34. Koh DM, Burke S, Davies N, et al. Transthoracic US of the chest wall: clinical uses and applications. Radiographics. 2002;22:e1.

    Article  PubMed  Google Scholar 

  35. Peng PW, Narouze S. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures. Reg Anesth Pain Med. 2009;34:458–74.

    Article  PubMed  Google Scholar 

  36. Strømskag KE, Kleiven S. Continuous intercostal and interpleural nerve blockades. Tech Reg Anesth Pain Manage. 1998;2:79–89.

    Article  Google Scholar 

  37. Reissig A, Kroegel C. Accuracy of transthoracic sonography in excluding post-interventional pneumothorax and hydropneumothorax: comparison to chest radiography. Eur J Radiol. 2005;53:463–70.

    Article  PubMed  Google Scholar 

  38. Moore DC, Bridenbaugh LD. Intercostal nerve block: indications, technique and complications. Anesth Analg. 1962;41:1–10.

    Article  CAS  PubMed  Google Scholar 

  39. Cohen SP, Sireci A, CL W, et al. Pulsed radiofrequency of the dorsal root ganglia is superior to pharmacotherapy or pulsed radiofrequency of the intercostal nerves in the treatment of chronic postsurgical thoracic pain. Pain Physician. 2006;9:227–35.

    PubMed  Google Scholar 

  40. Gollapalli L, Muppuri R. Paraplegia after intercostal neurolysis with phenol. J Pain Res. 2014;19(7):665–8.

    Article  Google Scholar 

  41. Dangoisse M, Collins S, Glynn CJ. Haemothorax after attempted intercostal catheterization. Anaesthesia. 1994;49:961–3.

    Article  CAS  PubMed  Google Scholar 

  42. Shanti CM, Carlin AM, Tyburski JG. Incidence of pneumothorax form intercostal nerve block for analgesia in rib fractures. J Trauma. 2001;51:536–9.

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. University of Texas Medical Branch, Galveston, TX, USA

    Scott Burlison

  2. Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA

    Gulshan R. Doulatram

Authors
  1. Scott Burlison
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  2. Gulshan R. Doulatram
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Corresponding author

Correspondence to Gulshan R. Doulatram .

Editor information

Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Joshua A. Hirsch

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Burlison, S., Doulatram, G.R. (2018). Chest Wall Blocks and Neurolysis. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_29

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  • DOI: https://doi.org/10.1007/978-3-319-60361-2_29

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60359-9

  • Online ISBN: 978-3-319-60361-2

  • eBook Packages: MedicineMedicine (R0)

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