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<br /> Ultrasound<br /> Ultrasound-guided<br /> intercostal nerve block<br /> Philips tutorial<br /> Hariharan Shankar, MD<br /> Associate Professor, Medical College of Wisconsin, Milwaukee, WI<br /> Vincent WS Chan, MD<br /> Professor, Department of Anesthesia, University of Toronto, Ontario, Canada<br /> Contents<br /> Ultrasound-guided intercostal nerve block<br /> 1 Introduction 3<br /> 2 Clinical anatomy 4<br /> 3 Sonoanatomy 8<br /> 4 Scanning technique 13<br /> 5 Nerve localization 18<br /> 6 Needle insertion technique 22<br /> 7 Clinical pearls 28<br /> 8 References 30<br /> Additional resources <a title="Philips Intercostal Nerve Block Tutorial page 1" href="http://viewer.zmags.com/publication/71781326?page=1"> Ultrasound Ultrasound-guided intercostal nerve b</a> <a title="Philips Intercostal Nerve Block Tutorial page 2" href="http://viewer.zmags.com/publication/71781326?page=2"> Contents Ultrasound-guided intercostal nerve bl</a> <a title="Philips Intercostal Nerve Block Tutorial page 3" href="http://viewer.zmags.com/publication/71781326?page=3"> 1 Introduction Intercostal nerve block</a> <a title="Philips Intercostal Nerve Block Tutorial page 4" href="http://viewer.zmags.com/publication/71781326?page=4"> 2 Clinical anatomy There are 12 ribs on each</a> <a title="Philips Intercostal Nerve Block Tutorial page 5" href="http://viewer.zmags.com/publication/71781326?page=5"> · An anterior branch that exits near the midline </a> <a title="Philips Intercostal Nerve Block Tutorial page 6" href="http://viewer.zmags.com/publication/71781326?page=6"> The ICNs provide muscular branches to the interco</a> <a title="Philips Intercostal Nerve Block Tutorial page 7" href="http://viewer.zmags.com/publication/71781326?page=7"> Deep to the innermost intercostal muscle is the p</a> <a title="Philips Intercostal Nerve Block Tutorial page 8" href="http://viewer.zmags.com/publication/71781326?page=8"> 3 Sonoanatomy · Even with a high-frequency t</a> <a title="Philips Intercostal Nerve Block Tutorial page 9" href="http://viewer.zmags.com/publication/71781326?page=9"> [Figure 2b] Sonogram of a transverse view demonst</a> <a title="Philips Intercostal Nerve Block Tutorial page 10" href="http://viewer.zmags.com/publication/71781326?page=10"> · The external and internal intercostal muscles a</a> <a title="Philips Intercostal Nerve Block Tutorial page 11" href="http://viewer.zmags.com/publication/71781326?page=11"> · The pleura line is a shimmering hyperechoic str</a> <a title="Philips Intercostal Nerve Block Tutorial page 12" href="http://viewer.zmags.com/publication/71781326?page=12"> [Figure 5] Sonogram of a transverse view demonstr</a> <a title="Philips Intercostal Nerve Block Tutorial page 13" href="http://viewer.zmags.com/publication/71781326?page=13"> 4 Scanning technique Position the patient </a> <a title="Philips Intercostal Nerve Block Tutorial page 14" href="http://viewer.zmags.com/publication/71781326?page=14"> · A useful technique to identify the level for bl</a> <a title="Philips Intercostal Nerve Block Tutorial page 15" href="http://viewer.zmags.com/publication/71781326?page=15"> [Figure 7] A high-frequency linear transducer is </a> <a title="Philips Intercostal Nerve Block Tutorial page 16" href="http://viewer.zmags.com/publication/71781326?page=16"> · A lower frequency transducer may be needed for </a> <a title="Philips Intercostal Nerve Block Tutorial page 17" href="http://viewer.zmags.com/publication/71781326?page=17"> [Figure 8] Sonogram of the parasagittal view dem</a> <a title="Philips Intercostal Nerve Block Tutorial page 18" href="http://viewer.zmags.com/publication/71781326?page=18"> 5 Nerve localization · Place a high-freque</a> <a title="Philips Intercostal Nerve Block Tutorial page 19" href="http://viewer.zmags.com/publication/71781326?page=19"> [Figure 9] Sonogram demonstrating a intercostal </a> <a title="Philips Intercostal Nerve Block Tutorial page 20" href="http://viewer.zmags.com/publication/71781326?page=20"> · Lateral to the costal angle, identify the exter</a> <a title="Philips Intercostal Nerve Block Tutorial page 21" href="http://viewer.zmags.com/publication/71781326?page=21"> [Figure 10] The surrogate ICN site is a hypoecho</a> <a title="Philips Intercostal Nerve Block Tutorial page 22" href="http://viewer.zmags.com/publication/71781326?page=22"> 6 Needle insertion technique Ultrasound-gu</a> <a title="Philips Intercostal Nerve Block Tutorial page 23" href="http://viewer.zmags.com/publication/71781326?page=23"> Parasagittal in-plane approach · With the transd</a> <a title="Philips Intercostal Nerve Block Tutorial page 24" href="http://viewer.zmags.com/publication/71781326?page=24"> [Figure 11] Sonogram of a parasagittal view with</a> <a title="Philips Intercostal Nerve Block Tutorial page 25" href="http://viewer.zmags.com/publication/71781326?page=25"> [ Video 1 ] Vide</a> <a title="Philips Intercostal Nerve Block Tutorial page 26" href="http://viewer.zmags.com/publication/71781326?page=26"> Parasagittal out-of-plane approach · With the tr</a> <a title="Philips Intercostal Nerve Block Tutorial page 27" href="http://viewer.zmags.com/publication/71781326?page=27"> Transverse approach · There is no clear indicati</a> <a title="Philips Intercostal Nerve Block Tutorial page 28" href="http://viewer.zmags.com/publication/71781326?page=28"> 7 Clinical pearls Incomplete block Misinter</a> <a title="Philips Intercostal Nerve Block Tutorial page 29" href="http://viewer.zmags.com/publication/71781326?page=29"> Needle visualization As visualization of a 25-G n</a> <a title="Philips Intercostal Nerve Block Tutorial page 30" href="http://viewer.zmags.com/publication/71781326?page=30"> 8 References 1. Patel SI, Joshi MY. Neurost</a> <a title="Philips Intercostal Nerve Block Tutorial page 31" href="http://viewer.zmags.com/publication/71781326?page=31"> Additional resources For additional resourc</a> <a title="Philips Intercostal Nerve Block Tutorial page 32" href="http://viewer.zmags.com/publication/71781326?page=32"> This paper reflects the opinion of the author, no</a>