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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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The mechanism behind interpleural anesthesia remains uncertain. As illustrated in Figure 34-1 , one mechanism proposed for interpleural anesthesia is that the local anesthetic diffuses from the pleural space through the intercostal membrane to reach the intercostal nerves along the chest wall. A second possible mechanism is that the local anesthetic is distributed through the pleura and into the region of the posterior mediastinum, at which point local anesthetic provides visceral analgesia by contacting the greater, lesser, and least splanchnic nerves. When more data become available, we will probably find that interpleural anesthesia results from a combination of these two mechanisms plus the absorption of enough local anesthetic from the pleural space to produce blood levels that promote systemic analgesia.

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