• E Piraccini, G Biondi, H Byrne, M Calli, D Bellantonio, G Musetti, and S Maitan.
• Department of Surgery, Anesthesia and Intensive, Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy.
• Eur J Pain. 2018 Oct 1; 22 (9): 1673-1677.

IntroductionPectoral Nerves Block (PECS) and Serratus Plane Block (SPB) have been used to treat persistent post-surgical pain after breast and thoracic surgery; however, they cannot block the internal mammary region, so a residual pain may occur in that region. Parasternal block (PSB) and Thoracic Transversus Plane Block (TTP) anaesthetize the anterior branches of T2-6 intercostal nerves thus they can provide analgesia to the internal mammary region.MethodsWe describe a 60-year-old man suffering from right post-thoracotomy pain syndrome with residual pain located in the internal mammary region after a successful treatment with PECS and SPB. We performed a PSB and TTP and hydrodissection of fascial planes with triamcinolone and Ropivacaine.ResultsPain disappeared and the result was maintained 3 months later.DiscussionThis report suggests that PSB and TTP with local anaesthetic and corticosteroid with hydrodissection of fascial planes might be useful to treat a post thoracotomy pain syndrome located in the internal mammary region.SignificanceThe use of Transversus Thoracic Plane and Parasternal Blocks and fascial planes hydrodissection as a novel therapeutic approach to treat a residual post thoracotomy pain syndrome even when already treated with Pectoral Nerves Block and Serratus Plane Block.© 2018 European Pain Federation - EFIC®.

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