Pectointercostal fascial plane block for rescue pain management of traumatic sternal fracture following inadequate thoracic epidural block: a case report

Abstract

Adequate pain control after multisystem trauma including the chest wall is essential for improved patient outcomes, especially with sternum and rib fractures. The thoracic epidural is considered the gold standard in pain management of thoracic injury; however, failure or patchy epidural is not uncommon. Pectointercostal fascial plane block (PIFB) is regularly used in cardiac surgery to provide analgesia to the anterior chest wall; however, there are few reports of PIFB being used as a primary block for the management of thoracic injuries. We present a case in which PIFB was used as a rescue block for the successful management of sternal pain following patchy thoracic epidural block in a patient with thoracic polytrauma.

Pecto-Intercostal Fascial Plane Block: Effect on the Postoperative Analgesia and Recovery After Off-PUMP Coronary Artery Bypass Surgery

“…These findings align with the results reported by Zhang et al (26,27) and Thomas et al (32). Pecto-intercostal fascial plane block has also been successfully employed for rescue analgesia in a patient who had extensive chest wall trauma and a sternal body fracture following an inadequate thoracic epidural block, resulting in marked improvement in ventilatory function (33). Additionally, it has been used to manage pain and facilitate weaning in a critically ill patient with retractable ribcage pain at the site of endothoracic drainage (34).…”

Awake Sternal Fixation Using the Ultrasound-Guided Superficial Parasternal Intercostal Plane Block in a Patient With Cervical Spine Fracture

“…Our case demonstrates that sternum surgery can be performed without general anesthesia, even in a patient with a traumatic sternal fracture, by implementing a bi-level, bilateral US-guided S-PIP block under sedation. US-guided S-PIP block was used for rescue pain management of traumatic sternal fracture [4] and rib cage pain in ICU patients [5]. Karapinar YE et al [6] have recently reported awake sternum revision with US-guided transverse thoracic muscle plane block, which is similar to our case.…”