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Deep parasternal intercostal plane nerve block: an anatomical study
  1. Monica W Harbell1,
  2. Natalie R Langley2,
  3. David P Seamans1,
  4. Molly B Kraus1,
  5. Frederick J Carey2 and
  6. Ryan C Craner1
  1. 1 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA
  2. 2 Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA
  1. Correspondence to Dr Monica W Harbell, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, USA; Harbell.Monica{at}


Introduction The superficial and deep parasternal intercostal plane (DPIP) blocks are two new blocks for thoracic pain. There are limited cadaveric studies evaluating the dye spread with these blocks. In this study, we examined the dye spread of an ultrasound-guided DPIP block in a human cadaveric model.

Methods Five ultrasound-guided DPIP blocks were performed in four unembalmed human cadavers using an in-plane approach with a linear transducer oriented in a transverse plane adjacent to the sternum. Twenty milliliters of 0.1% methylene blue were injected between ribs 3 and 4 into the plane deep to the internal intercostal muscles and superficial to the transversus thoracis muscle layer. The chest muscles were dissected, and the extent of dye spread was documented in both cephalocaudal and mediolateral directions.

Results The transversus thoracis muscle slips were stained in all cadavers from 4 to 6 levels. Intercostal nerves were dyed in all specimens. Four levels of intercostal nerves were dyed in each specimen with variability in number of levels stained above and below the level of the injection.

Conclusions The DPIP block spreads along the tissue plane above the transversus thoracis muscles to multiple levels to dye the intercostal nerves in this cadaver study. This block may be of clinical value for analgesia in anterior thoracic surgical procedures.

  • analgesia
  • Nerve Block
  • Ultrasonography

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @MonicaHarbellMD, @kraus_molly

  • Collaborators n/a.

  • Contributors Study design/planning, data acquisition, analysis, interpretation, writing manuscript, revision and approval of final manuscript: all authors. Guarantor: MH

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.