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The disadvantages of peripheral nerve block includes high concentrations of plasma level of drug due to high blood feeding around intercostal nerves, patients discomfort and prolonged neuralgia.
It was shown that the intercostal nerve was exposed to injury in 85% of the cadavers at the lateral border of the paraspinous muscle, and in 100% at both the mid-scapular line and the posterior axillary line.
1-3 Due to the several reports known about the underlying cause of the chronic post thoracotomy pain, intercostal nerve damage has been suggested to be the most common reason.
Post-mortem analyses indicated the continuity of intercostal nerve axons into the sacral roots and spinal cord.
Intercostal nerve blocks, Thoracic epidural, Opioids in the epidural space, and transcutaneous electrical nerve stimulation, can produce adequate analgesia but have their limitations along with possible side effects.
In another study, by Adnan et al incorporation of dexamethasone into bupivacaine microspheres significantly prolonged intercostal nerve block in sheep18.
We prospectively evaluated the effect of clonidine as an adjuvant to bupivacaine for continuous paravertebral intercostal nerve block, measuring pain and sedation scores and pulmonary function tests.
If the selected intercostal nerve was not of sufficient length to reach the specific lumbar region, a sural nerve segment was isolated, sheared into two segments, and attached to the intercostal nerve for grafting.
Sensory nerve supply is from second to fourth intercostal nerve.
In paravertebral block the anaesthetic agent is delivered to most logical space through which runs the intercostal nerve as it exits intervertebral foramina, its dorsal primary ramus (supplying posterior spinal muscles and costovertebral ligament strained at thoracotomy), its collateral branch (supplying the parietal pleura) and the sympathetic afferents on that side (supplying the visceral pleura).
He then proceeded to isolate an intercostal nerve from Yang's rib region, maintaining the nerve's connection to the spinal cord.