Case 15- Pecto-Intercostal Fascial Plane Block

Author: Dr Salman Naeem Reviewer: Dr Gokul Sagar Bailur/Dr Nick Mani

A 60-year-old gentleman presented after road traffic collision with severe central chest pain worse on inspiration. He was the driver wearing a seatbelt but was driving a vintage car without airbags. Palpation of the sternum and bilateral anterior medial chest revealed significant tenderness.

CT trauma imaging revealed a sternal fracture and bilateral anterior medial rib fractures. Ultrasound guided bilateral pecto-intercostal fascial plane single shot block was performed as shown:

Clip- Local anesthetic is injected between the pectoralis major and intercostal muscles at the 2nd or 3rd intercostal space, parasternal. This covers the anterior intercostal nerves, which innervate the anterior ribs and sternum.

Case Resolution

Ultrasound guided bilateral pecto-intercostal fascial plane single shock block successfully covered the anterior ribs and sternum fractures from trauma including CPR as a part of multimodal analgesia.

Take-home Message

Ultrasound guided plane, compartment, and nerve blocks either single shot or catheter placed are crucial in multimodal analgesia in selected patients.