Interpleural Analgesia in Treatment of Upper Extremity Reflex Sympathetic Dystrophy

Reiestad, Finn; McIlvaine, William B.; Kvalheim, Lars; Stokke, Trond; Pettersen, B

doi:10.1213/00000539-198911000-00022

Cited by 26 publications

(9 citation statements)

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“…The position of the patient can be optimised to facilitate local anaesthetic spread and block appropriate neural structures to achieve desired clinical effects. If blockade of the upper sympathetic ganglia is desired, as in the treatment of CRPS [20] or ischaemia affecting the upper limb [48], then the patient should be positioned with the affected side uppermost and with a 20° head‐down tilt to encourage cephalad spread in the paravertebral area. This position should be maintained for 30 min after injection to give the local anaesthetic time to penetrate the tissues.…”

Section: Techniquementioning

confidence: 99%

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Interpleural block – part 1

Dravid

Paul²

2007

Anaesthesia

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SummaryInterpleural blockade is effective in treating unilateral surgical and nonsurgical pain from the chest and upper abdomen in both the acute and chronic settings. It has been shown to provide safe, highquality analgesia after cholecystectomy, thoracotomy, renal and breast surgery, and for certain invasive radiological procedures of the renal and hepatobiliary systems. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, complex regional pain syndromes, thoracic and abdominal cancer, and pancreatitis. The technique is simple to learn and has both few contra-indications and a low incidence of complications. In the first of two reviews, the authors cover the history, taxonomy and anatomical considerations, the spread of local anaesthetic, and the mechanism of action, physiological, pharmacological and technical considerations in the performance of the block. Interpleural blockade is the technique of injecting local anaesthetic into the thoracic cage between the parietal and visceral pleura to produce ipsilateral somatic block of multiple thoracic dermatomes. There is evidence that it also produces pain relief by spread of local anaesthetic bilaterally to block both the sympathetic chains and the splanchnic nerves. It is effective in treating unilateral surgical and non-surgical pain from the chest and upper abdomen in both the acute and chronic settings. Local anaesthetic solutions can be administered as single or intermittent boluses, or as continuous infusions via an indwelling interpleural catheter. It has been shown to provide safe, high-quality analgesia after cholecystectomy, thoracotomy, renal and breast surgery, and for certain invasive radiological procedures of the renal and hepatobiliary systems. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, complex regional pain syndromes (CRPS), thoracic and abdominal cancer, and pancreatitis. The technique is simple to learn and has both few contraindications and a low incidence of complications. Interpleural blockade has not been widely adopted by the anaesthetic community largely because of concerns about pneumothorax and local anaesthetic toxicity. However, recent improvements in technique that enhance its safety, and increased experience with this form of treatment, suggest that a revisit to this interesting and useful technique of regional anaesthesia would be of value. In the first of this two-part review, we discuss the history, taxonomy and anatomical considerations, the spread of local anaesthetic, and the mechanism of action, physiological, pharmacological and technical considerations in the performance of the block. HistoryInterpleural injection was first described by Mandl in 1947 when he administered 6% phenol into the interpleural space of experimental animals without any evidence of pleural irritation or necrosis. Interest resurfaced in 1978, when Wallach used this space for therapy with tetracycline and lidocaine for malignant pleural effus...

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Section: Techniquementioning

confidence: 99%

“…Reiestad et al. [20] reported pain relief, lack of sweating, increased hand temperature and ipsilateral Horner's syndrome with this positioning. As O'Leary et al.…”

Section: Techniquementioning

confidence: 99%

Interpleural block – part 1

Dravid

Paul²

2007

Anaesthesia

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“…Reiestad and McIlvaine [36] have also reported unilateral block of the T1-T9 intercostal nerves, with complete skin anaesthesia sufficient to allow breast surgery. They recommend placing the patient in the lateral position with the affected side down and with a head-down tilt of 20°for 30 min after injection of the local anaesthetic.…”

Section: Breast Proceduresmentioning

confidence: 99%

“…Tumour invasion of the brachial plexus [68] Unilateral breast surgery [1,12,15,16] Open cholecystectomy [1][2][3][4][5][6][7][8][9][10][11] Pain of acute herpes zoster and post herpetic neuralgia [64][65][66][67] Needle localisation and breast biopsysole anaesthetic [15] Laparoscopic cholecystectomy [25,26] Chronic regional pain syndromes of the upper limb [36,61,63] Thoracotomy [42,43,45,[48][49][50][51] Renal surgery [1,[12][13][14] Upper limb ischaemia [62] Chest drain [108,109] Abdominal surgery (bilateral blocks) [55,56] Cardiac surgery [53,54] Percutaneous hepatic and biliary drainage procedures [27][28][29] Thoracic sympathectomy…”

Section: Head Neck and Upper Extremity Thorax Abdomenmentioning

confidence: 99%

“…These also suggest its effects on the sympathetic system in the amelioration of chronic pain. It has been used to treat pain from CRPS [36,61] and ischaemic conditions of the upper limb [62], acute herpes and postherpetic neuralgia of the head, neck and thorax [63][64][65][66][67], tumour involvement of the brachial plexus [68], pain in the pleura and chest wall from metastatic bronchogenic carcinoma [69], benign atypical chest pain [70], oesophageal cancer [71] and rupture pain [72], chronic pain in terminally ill patients with pancreatic, renal cell and breast cancers, lymphomas [73], upper abdominal cancers and chronic benign and neoplastic pancreatic pain [74][75][76][77][78][79]. Czop et al [61], in a prospective, randomised crossover study involving 10 patients, compared stellate ganglion blocks with interpleural block for CRPS of the upper extremity.…”

Section: Chronic Painmentioning

confidence: 99%

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Interpleural block – part 2

Dravid

Paul²

2007

Anaesthesia

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SummaryInterpleural blockade is effective in treating unilateral surgical and non-surgical pain from the chest and upper abdomen in both the acute and chronic settings. It has been shown to provide safe, highquality analgesia after cholecystectomy, thoracotomy, renal and breast surgery, and for certain invasive radiological procedures of the renal and hepatobiliary systems. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, complex regional pain syndromes, thoracic and abdominal cancer, and pancreatitis. The technique is simple to learn and has both few contra-indications and a low incidence of complications. In the second of two reviews, the authors cover the applications, complications, contra-indications and areas for future research. The interpleural route for the administration of local anaesthetic agents is capable of providing effective analgesia for postoperative, acute and chronic pain originating within the distribution of intercostal nerves. Local anaesthetic solutions can be administered as single or intermittent boluses, or as continuous infusions via an interpleural catheter. It has been shown to provide safe, high quality analgesia after cholecystectomy, thoracotomy, renal surgery and breast surgery, and for some invasive radiological procedures of the renal and hepatobiliary system. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, Complex Regional Pain Syndromes (CRPS), thoracic cancer, abdominal cancer and pancreatitis. The first part of this review focused on the history, anatomy, mechanism of action, technique and local anaesthetic dosage regimens for this block. In the second part, we consider the applications, complications, contra-indications and areas for future research. Indications for interpleural block

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Effect of Ultrasound‐Guided Intercostal Nerve Block Versus Fluoroscopy‐Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study

Lee

Park

Moon

et al. 2018

J of Ultrasound Medicine

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Objectives To compare the efficacy of a conventional fluoroscopy‐guided epidural nerve block and an ultrasound (US)‐guided intercostal nerve block in patients with thoracic herpes zoster (HZ). Methods This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1‐month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US‐guided intercostal nerve block or the fluoroscopy‐guided epidural nerve block approach with the addition of a 5‐mL mix of 2.5 mg of dexamethasone plus 0.5% lidocaine. The primary outcome measure was the NRS score reduction for the pain. Secondary outcomes included the duration of treatment, number of repeated injections until the final visit, and proportion of patients with pain relief after the first and final visits. Results All patients within both intervention groups showed significant pain relief on the NRS at the final follow‐up point (P < .05). There was no significant difference in the mean value of NRS improvement based on the intervention type. There was also no statistically significant difference in the duration of treatment and the frequency of injection for pain relief. Conclusions These findings showed that both the US‐guided intercostal nerve block and the fluoroscopy‐guided epidural nerve block were effective in patients with thoracic HZ. Compared data showed no significant differences in the pain reduction, duration of treatment, and frequency of injection. The US‐guided intercostal nerve block, which is more accessible than the fluoroscopy‐guided epidural nerve block, might be an alternative option for thoracic HZ.

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Interpleural Analgesia in Treatment of Upper Extremity Reflex Sympathetic Dystrophy

Cited by 26 publications

References 0 publications

Interpleural block – part 1

Interpleural block – part 1

Interpleural block – part 2

Effect of Ultrasound‐Guided Intercostal Nerve Block Versus Fluoroscopy‐Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study

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