A 51-year-old male is admitted to the hospital with severe dyspnea. Radiographic examination reveals a tension pneumothorax. Adequate local anesthesia of the chest wall prior to insertion of a chest tube is necessary for pain control. Of the following layers, which is the deepest that must be infiltrated with the local anesthetic to achieve adequate anesthesia?
The parietal pleura is innervated by the intercostal nerves and is very sensitive to pain, in this case being somatic innervation. Therefore, the parietal pleura is the deepest layer that must be anesthetized to reduce pain during aspiration or chest tube placement.
Endothoracic fascia
Intercostal muscles
Parietal pleura
Subcutaneous fat
Thorax