Abstract
IntroductionIntercostal nerve block and neurolysis are widely used procedures, but their injectate spread has not been well understood. Previous studies have reported unexpected outcomes (paravertebral or epidural anesthesia) and spinal cord injury after intercostal nerve block and neurolysis. To investigate a possible mechanism for these complications, we aimed to visualize the flow of liquid injected near the intercostal nerve, using cadavers.MethodsWe performed a simulated intercostal nerve block study using two Thiel-embalmed cadavers. Dye was injected into the interfascial plane between the internal and innermost intercostal muscles under ultrasound guidance (blue, 10 ml) or under direct vision (green, 5 ml).ResultsDye leakage began with injection of only 0.5–2 ml and occurred between the innermost intercostal muscle fibers. The dye injected around the intercostal nerve penetrated into the extrapleural space and reached the paravertebral space.ConclusionsInjectate placed around the intercostal nerve easily penetrate the extrapleural space and reach the paravertebral space. Intercostal nerve block or neurolysis has a risk of impairing at least the sympathetic chain and conceivably affecting the central nervous system.
Highlights
Intercostal nerve block and neurolysis are widely used procedures, but their injectate spread has not been well understood
Previous reports have found that total spinal anesthesia [5, 6] and persistent paraplegia [7,8,9,10] could occur after intercostal nerve block and neurolysis, respectively
We reported for the first time that agents injected to establish intercostal nerve block/neurolysis may reach the paravertebral space via the extrapleural space
Summary
Intercostal nerve block and neurolysis are widely used procedures, but their injectate spread has not been well understood. Previous studies have reported unexpected outcomes (paravertebral or epidural anesthesia) and spinal cord injury after intercostal nerve block and neurolysis. In the 1980s, a few reports suggested the possibility that injectate placed to establish an intercostal nerve block spread into the paravertebral space [1,2,3] or the epidural space [4]. The mechanisms by which local anesthetic and neurolytic agents, including phenol and alcohol, injected around the intercostal nerve (1) reach the paravertebral space or epidural space and (2) cause complications in the spinal cord remain unclear. To investigate a possible mechanism of these phenomena, we aimed to visualize the dynamic spreading of injectate following intercostal nerve block and neurolysis, using cadavers
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