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Background and Aims Analgesia for cardiac median sternotomy using pecto-intercostal fascial block (PIFB) after cardiac surgery has long been described. The ultrasound-guided PIFB can cover the anterior branches of intercostal nerves from T2 to T6 and reduce postoperative pain scores and opioid requirements in cardiac surgical patients.

Methods A 72-year-old man, ASA III, obese with COPD, was admitted to the ICU after a car crash with thoracic trauma (2nd to 5th anterior right ribs). Despite the introduction of multimodal intravenous analgesia (Paracetamol 1g 6/6h, Metamizol 1g 8/8h, Tramadol 100mg 8/8h, Morphine SOS), the pain was uncontrolled. Simultaneously, he developed a functional ileus which further compromised his respiratory function, requiring ventilatory support with a high-flow nasal cannula. The patient reported intense pain (VAS 10), to the anterior right side of the sternum, particularly with cough and deep inspiration. We performed an ultrasound-guided, single-shot, right PIFB, with 20mL of ropivacaine 0,2% without complications.

Results Twenty minutes after the PIFB, the patient reported a substantial improvement in thoracic pain (VAS 2/3), that lasted for 12h. For the duration of the block, the analgesic requirements decreased, and opioids were no longer needed. Laxatives were given and bowel function improved with a reduction of abdominal volume. Subsequently, pulmonary function improved, and ventilatory support decreased. He still required a nasal cannula but oxygen flow was reduced.

Conclusions The use of PIFB is an effective alternative analgesic approach for rib fracture of the anterior thorax, as it provides long-lasting analgesia, reduces opioid requirements, and its side effects, and improves respiratory function.