Poststernotomy neuralgia: a new pain syndrome.
Fifty-four patients developed severe intercostal neuralgia a few weeks after sternotomy. Immediate relief afforded by parasternal nerve blocks confirmed that the pain derived from scar-entrapped neuromas of the anterior rami of the first 4-6 intercostal nerves in the upper (and mainly left) interchondral spaces after insertion of the sternal wires. Permanent relief (i.e., over 6 months) followed repeated bupivacaine blocks in 57.4% of the patients, phenol blocks in another 22.2%, and alcohol blocks in a remaining 9%. Treatment was successful in 87% of the patients.
Department of Anesthesiology, University of Alabama, Birmingham.
R J
RJ
Defalque
J J
JJ
Bromley
D000328:Adult; D000368:Aged; D002045:Bupivacaine; D002921:Cicatrix / Q000150:complications; D000431:Ethanol; D006801:Humans; D007367:Intercostal Nerves / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009437:Neuralgia / Q000209:etiology* / Q000628:therapy; D010149:Postoperative Pain / Q000628:therapy*; D019800:Phenol; D010636:Phenols; D013249:Sternum / Q000601:surgery*
D010636:Phenols; D019800:Phenol; D000431:Ethanol; D002045:Bupivacaine