Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Seven. Intravenous Regional Blocks for the Upper & Lower Extremity > Chapter 44. Intercostal Nerve Block Anthony M-H. Ho, MD, Manoj K. Karmakar, MD

Intercostal Nerve Block: Introduction

"The intercostal nerves (ICNs) innervate the major parts of the skin and musculature of the chest and abdominal wall. The block of these nerves was first described by Braun in 1907, in the textbook Die Lokalanästesie.¹ In the 1940s, clinicians noticed that intercostal nerve blocks (ICNBs) could favorably effect a reduction in pulmonary complications and in narcotic requirements after upper abdominal surgery.¹ In 1981, continuous ICNB was introduced to overcome the problems associated with repeated multiple injections.¹ Today, ICNB is used in a great variety of acute and chronic pain conditions affecting the thorax and upper abdomen. Less commonly, it is also used for breast and minor chest wall surgery and, in combination with celiac plexus blockade, abdominal operations, usually with light sedation or general anesthesia. As with many other regional techniques, the advantages of ICNBs include superior analgesia, opioid-sparing effect, improved pulmonary mechanics, reduced central nervous system depression, and avoidance of urinary retention. It should be noted, however, that supplemental systemic analgesia is also almost always needed. The disadvantages of the technique include the requirement for technical expertise, risks of pneumothorax, and local anesthetic toxicity with multiple levels of blockade...."