Pectointercostal Fascial Block Catheters for Thoracic Injuries: A Case Series

Abstract

Providing analgesia for patients with anterior rib and sternum fracture has been addressed from various types of modalities. Regional anesthesia via epidurals or peripheral nerve blocks, opiates, and other forms of multimodal pain regimens have been used. However, in the polytraumatic injury patient, positioning for an epidural may be problematic, and a predominantly opiate-based treatment plan may compromise respiratory status. In this case series, we describe the pectointercostal fascial block as another tool to treat patients with anterior rib and sternal fracture with polytraumatic injuries. All 3 of the block's successes were evident by improvement in the respiratory status of each patient.

The Analgesic Effect of Ultrasound-guided Bilateral Pectointercostal Fascial Plane Block on Sternal Wound Pain After Open Heart Surgeries

“…14,21 Data from individual case reports have described PIFB as a successful technique for reducing opioid consumption, reducing pain scores, and improving poststernotomy patients' outcomes in both cardiac 22 and noncardiac surgeries. 23,24 Also, in recently published studies, Kumar et al 25 and Zhang et al 26 described similar results among patients who underwent open cardiac surgery. In contrast, in their randomized controlled trial involving open cardiac procedures, Khera et al 27 performed PIFB twice for their interventional group (immediately after surgery and on postoperative day 1).…”

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

“…Burns et al . described successful pain management in three trauma patients, all with anterior rib and sternal fractures [ 6 ]. However, Burns et al .…”

“…Its application in the trauma setting has not been widely studied. The literature is limited to a few case reports where PIFB is used as the primary block for managing sternal fractures [ 6 ]. We present the first case in which PIFB was used as a rescue block for successful management of sternal pain after patchy thoracic epidural.…”

Regional anesthesia for transplantation surgery – A white paper part 1: Thoracic transplantation surgery

“…Also knows as the PIFB, DPIPBs target the anterior intercostal nerves as they run in the fascial plane between the pectoral and intercostal muscles and emerge bilaterally at the sternum 24 . Ultrasound‐guided DPIPBs have been shown to improve respiratory function after anterior chest wall blunt trauma 25 . A single‐center, prospective, randomized, placebo controlled, quadruple‐blinded trial of 80 adult patients requiring median sternotomy for cardiac surgery showed a statistically significant reduction in visual analog scale (VAS) pain scores.…”

“…24 Ultrasound-guided DPIPBs have been shown to improve respiratory function after anterior chest wall blunt trauma. 25 A single-center, prospective, randomized, placebo controlled, quadruple-blinded trial of 80 adult patients requiring median sternotomy for cardiac surgery showed a statistically significant reduction in visual analog scale (VAS) pain scores.…”