Parasternal Nerve Blocks

In this video we discuss the anatomy and technique for performing blocks of the anterior cutaneous intercostal nerves just lateral to the sternum. Both the pecto-intercostal fascial block (PIFB) and the transversus thoracic plane block (TTP) are discussed, and their relatives merits compared

[@ravigwankhede]

Extremely well demonstration and illustration. Thank you for showing a clear video of important block which is not described commonly.

[@imiddleb]

This is great! Best explanation for PIFB that I've found. If doing this for a sternal fx visualizing the sternal fx with the US is very specific for presence of one. Performing this block at the level of the fracture bilaterally reduces the need for multiple level injections that is advocated for in literature.

[@gaborkiss7794]

Very well done and excellent work. Thanks a lot for your hard work and your clear explanations. I accidentenly jdiscovered this video on the web just today. NB: I also produced a video on the TTP block.

[@dr6627]

In the video you seem to be doing the TTPB between 2nd and 3rd ribs. Is this the most common location or could you go more superiorly/inferiorly also? Great video!

[@marcdefoe288]

@@regionalanesthesiology Great video 👍 How long do you quote for duration of block if done with single shots of ropivicaine or standard bupivicaine? Thanks!

[@Chocoecstasy]

Where is the external intercostal muscle?

[@MansoorAqil123]

The external intercostal muscle is located a little away from the lateral margin of the sternum, while the internal intercostal muscle lies close to the sternum. That is why when a needle is inserted close to the lateral margin of the sternum (while performing pecto-intercostal fascial plane block), reaches a plane between the pectoralis major and the internal intercostal muscle after penetrating the pectoralis major muscle.