50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Continuous Pectointercostal Fascial Plane Block for the
Acute Pain Patient with Anterior Chest Wall Trauma
Travis Bales, MD, Ipsit Shah, BA, Krystal Weierstahl, DO, Rozalin Thapa, DO
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI

Introduction

•Thoracic Epidurals are a mainstay of chest wall trauma, but there are many limitations

•Pectointercostal fascial plane blocks (PIFB) have been shown to improve pain management for anterior chest wall trauma1

•Limited study of continuous PIFB for use outside of cardiac surgery2

Methods

•MCW IRB approval obtained for retrospective review of electronic heath records

•11 patients were reviewed, one excluded for unilateral catheter, four excluded for death shortly after placement

•All catheters used a continuous infusion of 0.2% Ropivacaine of 6 mL per hour, except patient six who had a rate of 8 mL per hour.

Results/Discussion

•Group with diverse Mechanism of Injury

•Universal decrease in pain scores at 24 hours

•Two patients with significant Vital Capacity increases

•Can reduce amount of opioid needed post-injury

•Patient 6 had prior single injection PIFB following cardiac surgery with significant rebound pain. Pain greatly improved following catheter placement.

Conclusion

•Continuous PIFB is ideal for the difficult to position and/or anticoagulated patient with pain resulting from anterior chest wall trauma.

References

1.Burns LT, Beasley DA, Stevens MA, Crabtree DE, Mehaffey GR. Pectointercostal Fascial Block Catheters for Thoracic Injuries: A Case Series. A A Pract. 2018 Dec 15;11(12):340-343. doi: 10.1213/xaa.0000000000000821 PMID: 30085936

2.Zhang Y, Min J, Chen S. Continuous Pecto-Intercostal Fascial Block Provides Effective Analgesia in Patients Undergoing Open Cardiac Surgery: A Randomized Controlled Trial. Pain Med. 2022 Mar 2;23(3):440-447. doi: 10.1093/pm/pnab291. PMID: 34601602

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

CONTINUOUS PECTOINTERCOSTAL FASCIAL PLANE BLOCK (PIFB) FOR THE ACUTE PAIN PATIENT WITH ANTERIOR CHEST WALL TRAUMA

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