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Background and Aims Non-specific costal pain, characterized by flank thoracic pain caused by entrapment of nerve branches, remains a challenge for pain management physicians. In this study, we present a series of cases where patients with flank pain achieved clinical improvement through the use of NTLL plane block (figure 1), combining local anaesthetic and triamcinolone acetate.
Methods Case1 28-year-old female patient with persistent pain following retro-muscular periareolar breast augmentation. Despite implant removal, the pain persisted, and physical examination, thoracic electromyography, and nerve magnetic resonance imaging showed normal results. Case2 52-year-old patient underwent mastopexy with breast implants and experienced lateral thorax pain beyond the surgical innervation area. After the NTLL block, the pain subsided but returned to lower intensity after three weeks. Pulsed radiofrequency ablation of the NTLL was subsequently performed. Case3 41-year-old patient without relevant medical history experienced sudden-onset pain in the left lateral thorax after engaging in regular paddle tennis. Pain resolution occurred after the block, allowing the patient to resume sporting activities. Case4 37-year-old patient with no significant medical history, presenting with sudden-onset diffuse tenderness in the left costal area. Complete symptom resolution was achieved following the block.
Conclusions To our knowledge, this is the first case series describing neuropathic pain associated with the NTLL. It is important to note that while LACNES has been recently introduced, not all cases of thoracic wall pain can be attributed to this syndrome. Consideration of the innervation of the lateral thoracic wall and the potential contribution of the NTLL is crucial in diagnosing and managing such cases
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