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Ultrasound Guided Transversus Thoracic Plane block, Parasternal block and fascial planes hydrodissection for internal mammary post thoracotomy pain syndrome
Author(s) -
Piraccini E.,
Biondi G.,
Byrne H.,
Calli M.,
Bellantonio D.,
Musetti G.,
Maitan S.
Publication year - 2018
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1249
Subject(s) - parasternal line , medicine , thoracotomy , ropivacaine , surgery , thoracic wall , anesthesia , nerve block
Abstract Introduction Pectoral Nerves Block ( PECS ) and Serratus Plane Block ( SPB ) have been used to treat persistent post‐surgical pain after breast and thoracic surgery; however, they cannot block the internal mammary region, so a residual pain may occur in that region. Parasternal block ( PSB ) and Thoracic Transversus Plane Block ( TTP ) anaesthetize the anterior branches of T2‐6 intercostal nerves thus they can provide analgesia to the internal mammary region. Methods We describe a 60‐year‐old man suffering from right post‐thoracotomy pain syndrome with residual pain located in the internal mammary region after a successful treatment with PECS and SPB . We performed a PSB and TTP and hydrodissection of fascial planes with triamcinolone and Ropivacaine. Results Pain disappeared and the result was maintained 3 months later. Discussion This report suggests that PSB and TTP with local anaesthetic and corticosteroid with hydrodissection of fascial planes might be useful to treat a post thoracotomy pain syndrome located in the internal mammary region. Significance The use of Transversus Thoracic Plane and Parasternal Blocks and fascial planes hydrodissection as a novel therapeutic approach to treat a residual post thoracotomy pain syndrome even when already treated with Pectoral Nerves Block and Serratus Plane Block.