Ultrasound-Guided Intercostal Nerve Block

[@atchayad842]

Instantly subscribed when the animation began. Amazing video. Thank you so much for sharing !

[@Gerhard2770]

Thank you sooo much!! Used this method today and worked like a charm for rin fractures 5-8 Cannot thank you enough!

[@isaacra]

Definitely keeping the needle tip in your sight is the safest when especially giving blocks in these kind of critical places!

[@regionalanesthesiology]

Absolutely! I'm a BIG believer in intermittent squirts of saline as the needle approaches the pleura as well, just to be on the safe side in those cases where the needle is not perfect. Thanks for watching!

[@sasquatch4160]

Is the caudad cephalad label correct?

[@regionalanesthesiology]

Hmmm...I think I might have confused the issue by showing the needle coming from caudal on the patient's back a few seconds earlier. The labeling is correct though. Sorry for the confusion! Thanks for watching!

[@sudheeraks]

​@@regionalanesthesiology I have the same doubts. I think the labels are swapped. Intercostal neuro vascular bundle is located on the inferior aspect of superior rib. If the needle direction is correct, caudad should be replaced with cephalad.

[@SS-lw9go]

​@@sudheeraksAgree. If the label is correct, the procedure is incorrect.

[@AC-hj9tv]

Why do you like out of plane over in plane? How many levels can you do at once?

[@regionalanesthesiology]

I find that with in-plane, it can be hard to negotiate the needle over the rib and then get into the right location next to the pleura (depending on the patient). With out of plane, I won't expect to see my needle very well, BUT with hydrolocation, I can safely follow the tip down to the pleura by asking my assistant to give me intermittent squirts (0.5 mL) and watching for the expansion on the screen. With intercostal block, you really can only do one level at a time--the cephalocaudal spread is not like a paravertebral or epidural. So I do every level. Thanks for watching!

[@zakalobi80]

Very nice.

[@regionalanesthesiology]

Thanks! 🙏

[@AC-hj9tv]

The "woosh" sound when it said "in plane" was a jumpscare

[@regionalanesthesiology]

Got to keep you on your toes and make sure you're not falling asleep! 😉

[@vseavello]

"How inner? The most!" 😂🤣

[@regionalanesthesiology]

😊

[@raposky]

03:44 caudad and cephalad is written mistakenly contrast I think

[@regionalanesthesiology]

Hmmm...I think I might have confused the issue by showing the needle coming from caudal on the patient's back a few seconds earlier. The labeling is correct though. Sorry for the confusion! Thanks for watching!

[@luisenriquepc6398]

Better ESP ?

[@regionalanesthesiology]

I do think that if you can place local immediately adjacent to the pleura/nerve, you will get a dense, reliable block that can be used for surgical anesthesia. That is not always the case with ESP because you're relying on the local spreading ventral to the transverse process and some technical factors (intramuscular injection being the most common) can prevent that. So, yes, I do think if done properly, this (and paravertebral) would be more effective than ESP. I think a lot of us have come to the realization that: If you can do PVB/intercostal, then do that. If not, do an ESP. Hope that helps!

[@jankormandel8074]

I wd be interested but HECK you talk so frikkin fast!