Anatomical Variation in the Position of the Proximal Intercostal Nerve

Hardy, P.

doi:10.1093/bja/61.3.338

Cited by 35 publications

(15 citation statements)

References 6 publications

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“…The ninth, tenth and eleventh nerves are further away from the lower border of the cranial rib in the initial portion of their course than the upper thoracic intercostal nerves. In contrast with Hardy (1988), we consistently found the same anatomical pattern of the intercostal nerves in the posterior intercostal spaces. Their course is more oblique, running in a proximal and lateral direction, reaching the lower border of the cranial rib before the exit from the posterior intercostal space.…”

Section: Discussionmentioning

confidence: 41%

Multiple lumbar plexus neurotizations of the ninth, tenth, and eleventh intercostal nerves

et al. 2005

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The topographic anatomy of the lower intercostal nerves is less known than the upper ones except for the twelfth intercostal nerve. It is possible to use the lower intercostal nerves to carry out a neurotization of the lumbar roots. We studied the anatomy of the ninth, tenth, and eleventh intercostal nerves in order to specify the data of descriptive and topographic anatomy allowing to carry out their harvesting under good conditions. Ninth, tenth, and eleventh intercostal nerves of 50 cadavers were dissected. The proximal part of the nerve in the posterior intercostal space was exposed through a posterior approach. The lateral intercostal space was exposed through a lateral approach, under the latissimus dorsi, which made it possible to harvest the intercostals nerve. The proximal course of the nerve in posterior intercostals space was the same in all the cases. The nerve moves obliquely towards the outside to reach the lower border of the rib. The exit of posterior intercostal space is a fibrous strait that marks the entry of a channel between two muscular layers. We describe an aponevrotic channel in which the nerve and the vessels are, immediately at the lower border of the cranial rib. The mean total length of intercostal nerve harvested by our technique was 17.96 cm for the ninth intercostal nerve, 17.14 cm for the tenth intercostal nerve, and 15.94 cm for the eleventh intercostal nerve. The bifurcation of the intercostal nerve in a deep branch and the ramus cutaneus lateralis was found in the majority of the cases, from 9.5 to 21 cm of the emergence of the intercostal nerve in posterior intercostal space. This anatomical study of the ninth, tenth, and eleventh intercostal nerves in posterior intercostal space and lateral intercostal space appears to us to allow the realization of a reliable surgical harvesting.

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Section: Discussionmentioning

confidence: 41%

Multiple lumbar plexus neurotizations of the ninth, tenth, and eleventh intercostal nerves

et al. 2005

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“…Modification of this technique to use the middle of the space has been suggested to avoid damage to collateral intercostal arteries that run along the inferior rib (Da Rocha et al, 2002). Variation in the position of the intercostal nerve posteriorly has also been described with respect to intercostal nerve blocks (Hardy, 1988). We endeavoured to perform a comprehensive study of the neurovascular inter-relations in the mid-axillary line in the fifth and adjacent spaces to try to describe a 'Safe Zone' for drain insertion to minimise damage to associated structures.…”

Section: Introductionmentioning

confidence: 99%

Neurovascular anatomy and variation in the fourth, fifth, and sixth intercostal spaces in the mid-axillary line: A cadaveric study in respect of chest drain insertion

2005

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Chest drains are normally inserted in the fifth intercostal space in the mid-axillary line. The classical technique for chest drain insertion involves locating the drain in an interspace just superior to the inferior rib, so as to avoid the neurovascular bundle. While teaching thoracic wall anatomy on cadavers, considerable variation was noted in the position of the neurovascular bundles, frequently lying well away from the generally accepted subcostal groove. We endeavoured to perform a comprehensive cadaveric study of the neurovascular relationships in the mid-axillary line in the fifth and adjacent spaces to try to describe a 'Safe Zone' for drain insertion to minimise damage to associated structures. The idea that the neurovascular bundle is safely protected in the subcostal groove should be dispelled, as should the concept that there is nothing to damage in the zone immediately superior to the inferior rib. Clinicians should be aware that the Safe Zone is narrower than hitherto appreciated and should be between 50-70% of the way down an interspace to avoid the variably positioned superior intercostal neurovascular bundle and the inferior collateral artery.

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“…Thoracotomy pain may originate from the rib/periosteal/intercostal nerve complex (either in open or video‐assisted thoracotomies) (Khalil et al, ; Hardy ; Rogers, Henderson, Mahajan, & Duffy, ). However, intercostal nerve injury is a cornerstone in the subsequent development of neuropathic PTPS (Wildgaard et al, ).…”

Section: Discussionmentioning

confidence: 99%

The impact of ultrasound‐guided continuous serratus anterior plane block versus intravenous patient‐controlled analgesia on the incidence and severity of post‐thoracotomy pain syndrome: A randomized, controlled study

Reyad

Shaker

Ghobrial

et al. 2019

European Journal of Pain

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Objective The aim of this randomized controlled trial was to evaluate U/S guided serratus anterior plane catheter block (SAPB) versus patient‐controlled analgesia (PCA) on the emergence of post‐thoracotomy pain syndrome (PTPS) after thoracotomies for thoracic tumours. Methods This trial included 89 patients with chest malignancies, scheduled for thoracotomy were randomly allocated into two groups: Group A "PCA–group N=44" receiving patient‐controlled analgesia and group B "SAPB group N=45" where analgesia was provided by SAPB. The primary outcome measure was the assessment for the possible emergence of PTPS at 12 weeks. The secondary outcome measures were pain relief measured using visual analog scale (VAS) score, Quality of life was assessed using Flanagan Quality of Life Scale (QOLS) and Activity level was assessed using Barthel Activity of daily living (ADL) score. Results At week 8, PTPS incidence was significantly (p = .037) higher in the PCA group (45%) than in the SAPB group (24%) with a relative risk of 1.38 and 95% CI (1.01–1.9) while the incidence of PTPS at week 12 was significantly (p = .035) higher in the PCA group (43%) than in the SAPB group (22%) with a relative risk of 2.38 and 95% CI (1.23–4.57). The need for pain therapy in PTPS patients was significantly lower in the SAPB group (17.7%) than the PCA group (38.6%) (p = .028) at week 12. Pain intensity: VAS‐R and VAS‐D (pain scores at rest and with activity, respectively) was comparable (p > .05) between both groups at 6, 12, 18 and 24 hr, however VAS was significantly higher in the PCA group at week 8 (p = .046) and week 12 (p = .032) . Both groups were comparable regarding ADL and QOL scores (p > .05). Conclusion Serratus anterior plane block is assumed to be a good alternative for post‐thoracotomy analgesia following thoracotomies. The current work hypothesized that SAPB for a week postoperatively, may reduce the emergence of PTPS and may reduce the demand for pain therapy in those patients. Significance statement The current work hypothesized that SAPB for a week postoperatively, is a good loco‐regional alternative for post‐thoracotomy analgesia following thoracotomies for chest malignancies, it may reduce the emergence of PTPS and the demand for pain therapy in these patients.

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Anatomical Variation in the Position of the Proximal Intercostal Nerve

Abstract: Anatomical study of the proximal intercostal nerve in cadavers revealed three nerve forms, depending on the relation between the nerve and adjacent ribs. This was found in the classical subcostal position in 16.6%, in the midzone in 73% and in the inferior supracostal position in 10%.

Cited by 35 publications

References 6 publications

Multiple lumbar plexus neurotizations of the ninth, tenth, and eleventh intercostal nerves

Multiple lumbar plexus neurotizations of the ninth, tenth, and eleventh intercostal nerves

Neurovascular anatomy and variation in the fourth, fifth, and sixth intercostal spaces in the mid-axillary line: A cadaveric study in respect of chest drain insertion

The impact of ultrasound‐guided continuous serratus anterior plane block versus intravenous patient‐controlled analgesia on the incidence and severity of post‐thoracotomy pain syndrome: A randomized, controlled study

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