Intercostal/paraspinal nerve block for thoracic surgery

Recently, Anaesthesia has carried a number of descriptions of chest wall nerve blocks, derived from serratus plane block 1-4. However, serratus plane block is complicated intra-operatively when an implanted catheter impinges the surgical field. Instead, ultrasound identification of the paraspinal muscles near the T3/T4 spinous process in the lateral decubitus position enables local anesthetic infiltration (for example, 0.5 ml.kg−1 0.35% ropivacaine) via a 75 mm block needle between the extrathoracic fascia and paraspinal muscles, with the needle advanced cranio-caudally towards the lower ribs to provide maximal diffusion (Figs. 1 and 2). Catheter position within this space and continuous infusion of 8 ml.h−1 ropivacaine 0.2% can be used to provide analgesia for two or three days postoperatively. To date, we have performed this simple, reliable block for 21 patients undergoing thoracic surgery, who have required minimal postoperative analgesia, and one patient with thoracic trauma, which enabled early rehabilitation. No complications have occurred. We intend to investigate the analgesic potential of this block in a formal trial.