Book contents
- Cambridge Handbook of Anesthesiology
- Cambridge Handbook of Anesthesiology
- Copyright page
- Dedication
- Contents
- Contributors
- Introduction
- Chapter 1 Preoperative Evaluation and Coexisting Disease
- Chapter 2 Airway Management
- Chapter 3 Anesthesia Equipment: Clinical Considerations
- Chapter 4 Patient Monitoring
- Chapter 5 Inhalational Anesthetics
- Chapter 6 Intravenous Anesthetics and Adjunctive Agents
- Chapter 7 Pharmacology of Local Anesthetics
- Chapter 8 Anesthesia Techniques: Mild, Moderate, and Deep Sedation in Clinical Practice
- Chapter 9 Anesthesia Techniques: General Anesthesia Techniques in Clinical Practice
- Chapter 10 Postanesthesia Care Unit
- Chapter 11a Regional Anesthesia: Blocks of the Upper and Lower Extremities
- Chapter 11b Regional Anesthesia: Chest and Abdominal Plane Blocks
- Chapter 12 Fluid and Electrolyte Balance
- Chapter 13 Blood Transfusion Components and Complications in Anesthesiology
- Chapter 14 Cardiac Anesthesiology
- Chapter 15 Vascular Anesthesia
- Chapter 16 Thoracic Anesthesia
- Chapter 17 Neuroanesthesia
- Chapter 18 Renal Anesthesiology in Clinical Practice
- Chapter 19 Anesthesia for General Surgical Procedures
- Chapter 20 Anesthesia for Endocrine Diseases
- Chapter 21 Anesthesia for Neuromuscular and Collagen Vascular Diseases
- Chapter 22 Anesthesia for Ocular, Ear, and Throat Diseases
- Chapter 23 Orthopedic Anesthesia
- Chapter 24 Obstetric and Gynecologic Anesthesia
- Chapter 25 Pediatric Anesthesia
- Chapter 26 Geriatric Anesthesia
- Chapter 27 Anesthesia for Ambulatory Surgical Procedures
- Chapter 28 Chronic Pain Medicine
- Chapter 29 Acute Pain Management
- Chapter 30 Anesthetic Emergencies
- Chapter 31 Trauma Anesthesia
- Chapter 32 Perioperative Cognitive Disorders
- Chapter 33 Acute Pain Management in the ICU
- Chapter 34 Infection Control for the Anesthesia Provider
- Chapter 35 Coagulation
- Index
- References
Chapter 11b - Regional Anesthesia: Chest and Abdominal Plane Blocks
Published online by Cambridge University Press: 24 May 2023
- Cambridge Handbook of Anesthesiology
- Cambridge Handbook of Anesthesiology
- Copyright page
- Dedication
- Contents
- Contributors
- Introduction
- Chapter 1 Preoperative Evaluation and Coexisting Disease
- Chapter 2 Airway Management
- Chapter 3 Anesthesia Equipment: Clinical Considerations
- Chapter 4 Patient Monitoring
- Chapter 5 Inhalational Anesthetics
- Chapter 6 Intravenous Anesthetics and Adjunctive Agents
- Chapter 7 Pharmacology of Local Anesthetics
- Chapter 8 Anesthesia Techniques: Mild, Moderate, and Deep Sedation in Clinical Practice
- Chapter 9 Anesthesia Techniques: General Anesthesia Techniques in Clinical Practice
- Chapter 10 Postanesthesia Care Unit
- Chapter 11a Regional Anesthesia: Blocks of the Upper and Lower Extremities
- Chapter 11b Regional Anesthesia: Chest and Abdominal Plane Blocks
- Chapter 12 Fluid and Electrolyte Balance
- Chapter 13 Blood Transfusion Components and Complications in Anesthesiology
- Chapter 14 Cardiac Anesthesiology
- Chapter 15 Vascular Anesthesia
- Chapter 16 Thoracic Anesthesia
- Chapter 17 Neuroanesthesia
- Chapter 18 Renal Anesthesiology in Clinical Practice
- Chapter 19 Anesthesia for General Surgical Procedures
- Chapter 20 Anesthesia for Endocrine Diseases
- Chapter 21 Anesthesia for Neuromuscular and Collagen Vascular Diseases
- Chapter 22 Anesthesia for Ocular, Ear, and Throat Diseases
- Chapter 23 Orthopedic Anesthesia
- Chapter 24 Obstetric and Gynecologic Anesthesia
- Chapter 25 Pediatric Anesthesia
- Chapter 26 Geriatric Anesthesia
- Chapter 27 Anesthesia for Ambulatory Surgical Procedures
- Chapter 28 Chronic Pain Medicine
- Chapter 29 Acute Pain Management
- Chapter 30 Anesthetic Emergencies
- Chapter 31 Trauma Anesthesia
- Chapter 32 Perioperative Cognitive Disorders
- Chapter 33 Acute Pain Management in the ICU
- Chapter 34 Infection Control for the Anesthesia Provider
- Chapter 35 Coagulation
- Index
- References
Summary
The intercostal nerves are the continuations of the ventral ramus of the thoracic spinal nerves. To perform an effective ICB, the block should be performed proximal to the mid-axillary line, where the lateral cutaneous branch takes off. ICBs can be performed using landmarks, a nerve stimulator, or under ultrasound guidance. Evidence supports the effectiveness of ICBs for chest tube placement, rib fractures, and procedures of the breast and chest wall. Limitations of ICBs include the need to perform blocks at multiple levels (each level of fractured rib) and their association with a shorter duration of action, compared to other chest wall fascial plane blocks such as pectoralis (PECS) II block and serratus anterior plane block (SAP). This is mainly related to a high rate of absorption of local anesthetic within the intercostal space. These considerations make ICBs a less favorable option, as with each injection, there is a potential risk of complications, such as neurovascular injury and pneumothorax. The risk of local anesthetic systemic toxicity (LAST) may also be increased with multiple intercostal injections related to the highly vascularized bundle located underneath each rib, resulting in a high rate of absorption.
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- Cambridge Handbook of Anesthesiology , pp. 173 - 181Publisher: Cambridge University PressPrint publication year: 2023