Department of Surgery, Anesthesia and Intensive, Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy.
Anesthesia and Intensive Care, University of Ferrara, Italy.
Eur J Pain. 2018 Oct;22(9):1673-1677. doi: 10.1002/ejp.1249. Epub 2018 May 31.
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.
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.
Pain disappeared and the result was maintained 3 months later.
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.
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.
胸大肌神经阻滞（PECS）和胸肌平面阻滞（SPB）已被用于治疗乳腺和胸外科手术后持续的术后疼痛；然而，它们不能阻滞肋间内肌区域，因此该区域可能会出现残余疼痛。胸骨旁阻滞（PSB）和胸横突平面阻滞（TTP）麻醉 T2-6 肋间神经的前支，因此可以为肋间内肌区域提供镇痛。
我们描述了一位 60 岁男性，在成功接受 PECS 和 SPB 治疗后，患有右胸手术后疼痛综合征，残留疼痛位于肋间内肌区域。我们进行了 PSB 和 TTP 以及用曲安奈德和罗哌卡因进行筋膜平面的水分离。
疼痛消失，3 个月后结果仍然维持。
本报告表明，局部麻醉药和皮质类固醇的 PSB 和 TTP 联合筋膜平面的水分离可能有助于治疗位于肋间内肌区域的胸手术后疼痛综合征。
使用经胸横突平面和胸骨旁阻滞以及筋膜平面水分离作为一种新的治疗方法，甚至可以治疗已经接受过胸大肌神经阻滞和胸肌平面阻滞的胸手术后疼痛综合征。
