Nunn J F, Slavin G
Br J Anaesth. 1980 Mar;52(3):253-60. doi: 10.1093/bja/52.3.253.
The human intercostal space has been studied by excision of the posterior part of the rib cage at autopsy, followed by fixation, decalcification, section and staining. Injection of India ink was used to simulate local anaesthetic. At a point 7 cm from the midline, the distance from the posterior aspect of the rib to the pleura averaged 8 mm. The intercostal nerve usually comprises a number of small bundles without any enclosing fascial sheath. The bundles lie in a triangular space bounded by the rib, the posterior intercostal membrane and the intercostalis intima muscle. The first two appear impervious to the spread of an injected solution, but the last permits spread of the injection round the internal aspect of the rib to gain access to the intercostal spaces above and below that into which the injection has been made. An injection of 3 ml will also spread medially to enter the paravertebral space and surround the sympathetic chain. A small clinical study gave excellent analgesia after operation for a mean duration of 12.3 h following unilateral intercostal block with 3 ml of bupivacaine 0.5% (with adrenaline) into each of the intercostal spaces T5-11, before cholecystectomy through a subcostal incision. There were no complications in the series.
通过在尸检时切除胸廓后部肋骨，随后进行固定、脱钙、切片和染色，对人体肋间间隙进行了研究。注入印度墨水以模拟局部麻醉剂。在距中线7厘米处，肋骨后缘至胸膜的平均距离为8毫米。肋间神经通常由许多小束组成，没有任何包裹的筋膜鞘。这些束位于由肋骨、肋间后膜和肋间内膜肌界定的三角形空间内。前两根肋间神经似乎对注入溶液的扩散具有抗性，但最后一根允许注射剂围绕肋骨内侧扩散，从而进入注射部位上方和下方的肋间间隙。注入3毫升溶液也会向内侧扩散，进入椎旁间隙并包围交感神经链。一项小型临床研究表明，在通过肋下切口进行胆囊切除术之前，向T5 - 11肋间间隙各注入3毫升0.5%布比卡因（含肾上腺素）进行单侧肋间阻滞，术后平均镇痛时间为12.3小时，效果极佳。该系列研究中无并发症发生。
