Modified Superficial parasternal intercostal plane block as the main anesthetic method in sternum revision surgery: a case report
Dilan Akyurt, Aynur Kaynar, Hüseyin Ağırbaş, Emrah Erener, Serkan Tulgar
Samsun University, Faculty of Medicine
Giriş: As in all anesthesia practice, facial plane blocks are frequently preferred in cardiothoracic anesthesia, in perioperative analgesia and sometimes as the main anesthesia method. (1). Our aim was to present a modified superficial parasternal intercostal nerve block, which was successfully used as an alternative to general anesthesia in an ASA III patient who was scheduled for sternal revision after open heart surgery.
Olgu: Sternal revision was planned for a 30-year-old female patient with a 60 kg weight who had undergone mitral annuloplasty with midline sternotomy. General anesthesia was considered as high risk for the co-morbid patient with a peripheral 02 saturation of 78% with nasal 02 support and it was decided to prefer regional anesthesia as the main anesthesia method. Superficial parasternal intercostal plane block with sedation was applied bilaterally from the level of the 3rd and 5th costal cartilages. A complementary block was planned due to wound went down to 2-3 cm below the xifoid and two drains in the epigastric region. Local anesthetic was applied bilaterally into interfascial plane between Rectus abdominis muscle and costal cartilage, just lateral to the junction of the 6th-7th costal cartilages to the sternum. A total of 60 mL of LA was injected. Intravenous propofol infusion was started for mild sedation. After the success of the block was confirmed with a pinpirick test, surgery was started. The patient who reported mild to moderate pain in the sternal notch area received 10 mg i.v. ketamine was administered, twice. The procedure was lasted approximately 55 minutes and patients was transferred to the intensive care unit. There was no need for analgesia for the first 9 hours postoperatively.
Tartışma ve Sonuç: We believe that modified superficial parasternal intercostal plane block may be a good alternative in cases of sternum revision in which general anesthesia is at high risk.
|