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Abstract
Background and Aims Thoracic Outlet Syndrome (TOS)1 comprehends compression of the nerves, arteries and veins of the arm caused by supernumerary rib. Surgical resection is the definitive treatment when conservative therapy fails (Figure 1). We have tried to combine modified supraclavicular brachial block (M-SBP) and pectoserratus plane (PSP)2block as anaesthetic and analgesic technique.
Methods Written informed consent was obtained from a female (age 43) and a male (age 30) candidated to trans-axillary left supernumerary first rib resection. M-SBP block were performed with 10 mL of 2% carbocyanine, reaching the brachial plexus and the first rib periosteum (Figure 2). PSP block3were performed over the third rib, injecting 15 mL of 7,5% ropivacaine between the pectoralis minor and serratus anterior (Figure 3). Surgery was carried out in spontaneous breathing under sedation with Propofol 2% continuous infusion. During the opening of the pleura, the lung collapsed, facilitating surgical manoeuvres, and finally reducing surgical timing and lung injuries.
Results M-SBP block successfully abolished pain and reflexes during the ribs resection. SPS block provided anaesthesia of pectoralis nerves, clavipectoral fascia, intercosto-brachial nerve, and lateral cutaneous branch. No additional opiates were needed. On postoperative day one NRS was zero, and pleura drainage was removed without discomfort; at three weeks follow-up patients did not report thoracic pain or complications.
Conclusions Even though large studies are needed, the combination of these two blocks seems to be a promising anaesthetic and analgesic technique in patients who need TOS decompression surgery, enhancing patient safety and comfort.