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Case Reports
. 2019 Oct-Dec;13(4):365-367.
doi: 10.4103/sja.SJA_773_18.

Novel block and new indication: Ultrasound-guided continuous "mid-point transverse process to pleura" block in a patient with multiple rib fractures

Rashmi Syal  1 , Rakesh Kumar  1 , Manoj Kamal  1 , Pradeep Bhatia  1
Affiliations
Case Reports

Novel block and new indication: Ultrasound-guided continuous "mid-point transverse process to pleura" block in a patient with multiple rib fractures

Rashmi Syal et al. Saudi J Anaesth. 2019 Oct-Dec.

Abstract

To avoid the complications related to thoracic epidural and paravertebral block, we performed mid-point transverse process to pleura (MTP) block in a patient with multiple rib fractures. A patient with 2nd--5th rib fractures came with complains of severe pain and difficulty in breathing. Ultrasound (US)-guided continuous MTP block was given at T4 level and 15 ml of 0.375% ropivacaine was deposited, followed by the catheter insertion at the same level. Patient reported decreased sensation from T2--T8 dermatomes and reduced VAS scores from 9/10 to 1/10 within 20 min of block insertion. Continuous MTP block is efficacious in providing thoracic analgesia and has higher safety margin as needle is inserted further away from pleura.

Keywords: Mid-point transverse process to pleura; multiple rib fractures; pain; thoracic epidural.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Shows the Chest X-Ray of patient
Figure 2
Figure 2
Schematic diagram showing the site of MTP block
Figure 3
Figure 3
Patient in sitting position with high-frequency probe placed over the transverse process and needling from cranial to caudal direction
Figure 4
Figure 4
Image of US guided MTP block: Sagittal view - T3-T4 transverse process, (a) before local anesthetic (LA) deposition; arrow indicates needle direction from cranial to caudal. (b) after LA deposition ***LA spread
See this image and copyright information in PMC

References

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