Injuries of the Nerves of the Thorax

Ostrowska, Monika; Carvalho, Mamede de

doi:10.1016/b978-0-12-802653-3.00083-x

Cited by 5 publications

(7 citation statements)

References 185 publications

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“…4). The intercostal nerves terminate here in anterior cutaneous branches which ascend through the intercostal and pectoralis major muscles to innervate the superficial tissues of the parasternal region [11]. The anterior branches of intercostal nerves can, therefore, be targeted in two fascial planes in the parasternal region: deep to pectoralis major and superficial to intercostal muscles (the superficial parasternal‐intercostal plane); and deep to intercostal muscles but superficial to transversus thoracis muscles (the deep parasternal‐intercostal plane; Fig.…”

Section: Anatomymentioning

confidence: 99%

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Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

2021

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Summary Ultrasound‐guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high‐quality randomised controlled trials focusing on patient‐centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.

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Section: Anatomymentioning

confidence: 99%

Section: Anteromedial Chest Wallmentioning

confidence: 99%

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

2021

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“…The phrenic nerve is the longest branch of the cervical plexus and enters the thorax through the superior thoracic aperture, between the subclavian artery and vein. 1 The phrenic nerve descends, crossing the apex of the right or left pleural cavity, coursing between the mediastinal pleura and the pericardium. 2 Phrenic nerve injury is a well-recognized complication of surgery.…”

Section: See Commentaries On Pages 1623 and 1625mentioning

confidence: 99%

Association of chest tube position with phrenic nerve palsy after neonatal and infant cardiac surgery

Ghani

Foster

Shannon

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…6 As the longest branch of the cervical plexus, it begins its journey from the neck and travels from a lateral position medially over the anterior scalenus anterior muscle. 7 The nerve then descends vertically behind the prevertebral fascia posterior to the sternocleidomastoid, internal jugular vein, thoracic duct, and several other important structures in the neck before finally entering the thorax through the superior thoracic aperture. 7 The right and left phrenic nerves differ slightly in their routes.…”

Section: Pathophysiologymentioning

confidence: 99%

“…7 The nerve then descends vertically behind the prevertebral fascia posterior to the sternocleidomastoid, internal jugular vein, thoracic duct, and several other important structures in the neck before finally entering the thorax through the superior thoracic aperture. 7 The right and left phrenic nerves differ slightly in their routes. The shorter and more vertical right nerve descends lateral to the brachiocephalic nerve and the superior caval vein towards the pericardium covering the right atrium and inferior caval vein.…”

Section: Pathophysiologymentioning

confidence: 99%

Management of phrenic nerve injury post-cardiac surgery in the paediatric patient

et al. 2021

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Background: Phrenic nerve injury is a common complication of cardiac and thoracic surgical procedures, with potentially severe effects on the health of a child. This review aims to summarise the available literature on the diagnosis and management of PNI post-cardiac surgery in paediatric patients with CHD. Main body: The presence of injury post-surgery can be difficult to detect and may present with non-specific symptoms, emphasising the importance of an effective diagnostic strategy. Chest X-ray is usually the first investigation for a suspected diagnosis of PNI, which is usually confirmed using fluoroscopy, ultrasound scan, or phrenic nerve stimulation (gold standard). Management options include supportive ventilation and/or invasive diaphragmatic plication surgery. While the optimal timing of plication surgery remains controversial, it is now the most widely accepted treatment for PNI in children post-CHD surgery, especially for very young patients who cannot be weaned off supportive ventilation. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children. Conclusion: PNI is a common and serious complication of CHD surgery, therefore, its diagnosis and management in the paediatric population are of major importance. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children.

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Injuries of the Nerves of the Thorax

Cited by 5 publications

References 185 publications

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

Association of chest tube position with phrenic nerve palsy after neonatal and infant cardiac surgery

Management of phrenic nerve injury post-cardiac surgery in the paediatric patient

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