The ultimate technique for posterior rib fractures: the parascapular sub-iliocostalis plane block - A series of cases

C R Almeida; L Vieira; B Alves; G Sousa; P Cunha; P Antunes

doi:10.1016/j.redare.2023.09.003

The ultimate technique for posterior rib fractures: the parascapular sub-iliocostalis plane block - A series of cases

Rev Esp Anestesiol Reanim (Engl Ed). 2023 Oct;70(8):477-482. doi: 10.1016/j.redare.2023.09.003. Epub 2023 Sep 6.

Authors

C R Almeida¹, L Vieira¹, B Alves², G Sousa¹, P Cunha¹, P Antunes¹

Affiliations

¹ Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
² Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal. Electronic address: barbarabiscaia24@gmail.com.

PMID: 37678457
DOI: 10.1016/j.redare.2023.09.003

Abstract

We report retrospectively a series of four cases involving the successful use of the recently described parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures. The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) medial spread below the ESM, to reach the posterior spinal nerves; and (4) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects and other possible complications associated to other techniques leading that the PSIP may be considered an alternative in some clinical scenarios to the Erector Spinae Plane block or the Paravertebral block.

Keywords: Bloqueo PSIP; Bloqueo nervioso; Ecografía; Fracturas de costillas; Nerve block; PSIP block; Rib fractures; Ultrasonography.

Publication types

Case Reports