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Case Reports
. 2020 Apr-Jun;14(2):224-227.
doi: 10.4103/sja.SJA_575_19. Epub 2020 Mar 5.

Ultrasound-guided bilateral parasternal block: A boon for managing pain after sternal fracture/dislocation

Sandeep Diwan  1 , Abhijit Nair  2
Affiliations
Case Reports

Ultrasound-guided bilateral parasternal block: A boon for managing pain after sternal fracture/dislocation

Sandeep Diwan et al. Saudi J Anaesth. 2020 Apr-Jun.

Abstract

Sternal fractures are high velocity injuries which is associated with thoracic or lumbar vertebral fractures. Severe pain associated with sternal fractures can lead to impaired ventilation, low partial pressure of arterial oxygen, need of non-invasive or invasive ventilation with an endotracheal tube thereby leading to significant morbidity. In a series of three patients with manubrium sternal dislocation, we administered continuous bilateral parasternal blocks and initiated infusion of local anesthetics for different periods of time in all patients. The high pain scores drastically decreased followed by improved spontaneous ventilation. There was improvement in partial pressure of oxygen in arterial blood gas. None of the patient required a non-invasive or invasive ventilation. The spread of local anesthetic using injection of radio-opaque contrast through bilaterally placed parasternal catheters was followed by a computed tomography scan. This was done after obtaining informed consent from patient and waiver for scan. To the best of our knowledge, this is first report of successful pain management in patients who sustained manubrium - sternal dislocations using bilateral continuous catheters for a prolonged period.

Keywords: Anaesthesia; fracture; pain; regional; sternum; ultrasound.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Ultrasonography (USG) image showing manubriosternal dislocation. (b) USG image showing the relationship of IMA, pleura, rib, and pericardium (IMA- internal mammary artery, TTM- transversus thoracis muscle). (c) Image showing the desired plane between the pectoralis major and external intercostal muscle (EIM). (d) Image showing needle entry in the interfascial plane
Figure 2
Figure 2
(a) Image showing the direction of needle entry (caudo-cranial) and probe placement. (b) The axial view after injecting contrast showing the spread of the contrast below and around the pectoralis major and above the EIM on the right side and on the left the contrast spreads deeper below the EIM. (c) The sagittal view after contrast injection depicts the catheter coursing below the sternum and contrast spread below the manubrium and sternum. (d) The coronal view after contrast shows spread in the retrosternal area and as far as the parasternal to intercostal area
See this image and copyright information in PMC

References

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