Truncal Regional Analgesia for Thoracic Trauma

Abstract

Abstract Purpose of Review Pain from chest wall trauma can worsen breathing in thoracic trauma patients and contribute to pulmonary complications. Standard analgesia with parenteral opioids and thoracic epidural analgesia can be very effective but cannot always be implemented safely. Alternative thoracic fascial plane blocks are emerging as alternative techniques. Recent Findings Truncal regional anesthesia uses ultrasound to administer a local anesthetic into an anatomic potential space adjacent to sensory nerves, providing pain relief to the areas supplied by those nerves. Catheter techniques can be an option for persistent pain relief. Posterior thoracic blocks include the paravertebral block and the erector spinae plane block and are proposed for posterior chest injuries. The serratus anterior plane block is a lateral wall block for anesthesia of the anterolateral chest. Intercostal nerve blocks and parasternal blocks are options for anterior sternal fractures. Experimental blocks have also been proposed. Summary Fascial plane blocks of the chest wall have emerged as modalities to treat pain from thoracic wall trauma. These blocks may have a role as alternatives to thoracic epidurals for some patients.