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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 33 – Intercostal Block

PERSPECTIVE

Intercostal nerve blocks provide unexcelled analgesia of the body wall. Thus, it is appropriate to use the technique for analgesia after upper abdominal and thoracic surgery or for rib fracture analgesia. It is possible to perform minor surgical procedures on the chest or abdominal wall using only intercostal blocks, but some supplementation is often appropriate to complement this block. The intercostal block can also be used when chest tubes (thoracostomy tubes) are placed or when feeding gastrostomy tubes are inserted.

Patient Selection.

All patients are candidates for this block, although it should be realized that as patients become more obese the blocks are technically more difficult to carry out.

Pharmacologic Choice.

As for any decision about local anesthetic choice, it must be decided whether motor blockade is required for a successful block. If the intercostal nerve block is combined with light general anesthesia for intra-abdominal surgery and the intercostal block is prescribed to provide abdominal muscle relaxation, a higher concentration of local anesthetic is needed. In this setting, 0.5% bupivacaine or ropivacaine, 1.5% lidocaine, or 1.5% mepivacaine is an appropriate choice. Conversely, if sensory analgesia is all that is necessary from the block, 0.25% bupivacaine, 0.2% ropivacaine, 1% lidocaine, or 1% mepivacaine is appropriate.

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