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Related Concept Videos

Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

876
Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve
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Deep parasternal intercostal plane nerve block: an anatomical study.

Monica W Harbell1, Natalie R Langley2, David P Seamans3

  • 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA Harbell.Monica@mayo.edu.

Regional Anesthesia and Pain Medicine
|July 7, 2023
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Summary

The deep parasternal intercostal plane (DPIP) block effectively spreads dye to intercostal nerves across multiple levels in cadavers. This ultrasound-guided technique shows promise for managing anterior thoracic pain.

Keywords:
Nerve BlockREGIONAL ANESTHESIAUltrasonographyanalgesia

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Area of Science:

  • Anesthesiology
  • Anatomy
  • Pain Management

Background:

  • Superficial and deep parasternal intercostal plane (DPIP) blocks are novel techniques for thoracic pain management.
  • Limited cadaveric studies exist on the dye spread patterns of these blocks.

Purpose of the Study:

  • To investigate the dye spread of an ultrasound-guided DPIP block in a human cadaveric model.
  • To evaluate the anatomical distribution and potential clinical utility of the DPIP block.

Main Methods:

  • Five ultrasound-guided DPIP blocks were performed in four unembalmed human cadavers.
  • 20 mL of 0.1% methylene blue was injected between ribs 3 and 4, deep to internal intercostal muscles.
  • Dye spread was assessed via dissection in cephalocaudal and mediolateral directions.

Main Results:

  • The dye stained transversus thoracis muscle slips across 4 to 6 levels in all cadavers.
  • Intercostal nerves were dyed in all specimens, with an average of four levels stained per injection.
  • Dye distribution demonstrated spread both above and below the injection site.

Conclusions:

  • The DPIP block facilitates dye spread along the tissue plane superficial to the transversus thoracis muscles.
  • This block effectively targets multiple intercostal nerve levels, suggesting clinical value for anterior thoracic surgical analgesia.