New cutting-edge "Ropivacaine" for intercostal nerve blocks at the end of the case rather than older Marcaine (Ropivaciane is a pure esther that has much less cardiac and central nervous system toxicities when compared to Marcaine).

Precise division of the sympathetic nerve is much less painful than clamping (partial pleurectomy not required with precise Micro ETS).

Kuntz nerves are precisely divided where they cross the 2nd rib with my Micro ETS technique (less pain and bleeding).

Clamping the sympathetic nerve may gather surrounding tissue in the clamp causing bleeding, scar tissue, and pain if a nearby intercostal artery, nerve, or nearby tissue is clamped where the sympathetic nerve crosses perpendicular to these structures.

Clamping often requires not only the surround tissues around the sympathetic nerve to be dissected away but pulling on the nerve with a nerve hook to align the sympathetic nerve with the clamping device so clamping can be performed.