Continuous intercostal and interpleural nerve blockades

Abstract

The intercostal nerves represent the anterior primary division of the first through 12th thoracic spinal nerves. They supply the major parts of the skin and musculature of the chest and abdominal wall. Intercostal nerve blockade is one of the oldest peripheral nerve blockades, being first described in 1907. The indications are extended, and in 1980 the continuous technique was described. In 1984 the first report of interpleural blockade was published. Both methods are technically simple, safe, and effective in the control of both acute and chronic pain originating within the distribution of the intercostal nerves. Standard technique for both continuous intercostal and interpleural blockade is to use a catheter, start with a bolus dose and continue with a infusion of bupivacaine with epinephrine. The recommended dose for intercostal block is 2 mg/kg/4 hr of 0.5% bupivacaine and for interpleural blockade 5 to 10 mL/hr of 0.25% bupivacaine with epinephrine. The plasma concentration of local anesthetics after using this administration is under the toxic level of 4.0 μg/mL.