Intercostal neuralgia is one of the dreaded complications of thoracotomy. There is evidence that neuralgia is due to nerve injury from pressure applied by the rib spreader.

In this video I demonstrate how I dissect the intercostal neurovascular bundle from the rib above the thoracotomy and place the upper blade of the rib spreader between the rib an the bundle, thus avoiding direct pressure on the intercostal nerve.