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...

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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Malignant peripheral nerve sheath tumor (MPNST) refers to spindle cell sarcomas arising from or separating in the direction of cells of peripheral nerve sheath. The MPNST of the parotid gland is an extremely rare tumor, accounts for < 5% of all soft tissue sarcomas, and carries a poor prognosis. In this article, we report a case of MPNST of parotid gland in a 45-year-old male and review its diagnostic and therapeutic challenges. A 45-year-old male presented with right parotid swelling for 2 years with rapid increase in size over the last 3 months. He underwent right total conservative parotidectomy with selective neck dissection. Reconstruction was done with microvascular anterolateral thigh flap. On immunohistochemistry, the tumor cells expressed CD 56 diffusely and S 100 focally. Tumor was immunonegative for CK, Desmin, SOX -10, and SMA consistent with MPNST. The MPNSTs arising as parotid mass are very rare and aggressive tumors. The role of IHC is paramount in establishing the diagnosis. Multimodal management including wide surgical resection, neck dissection, and adjuvant chemoradiotherapy is the choice of treatment.