PARASTERNAL BLOCK: AN EXPERIENCE REPORT
Keywords:
Anesthesia, Branch block, Intercostal nervesAbstract
Introduction: Parasternal block is a regional anesthesia technique used for analgesia in thoracic surgeries, providing comfort and reducing postoperative opioid use. Guided by ultrasound, the block targets the anterior cutaneous branches of the intercostal nerves in the fascial plane between the pectoralis major and external intercostal muscles. Objective: To report the experience of second-year medical students in a parasternal block procedure following a cardiac valve replacement surgery due to mitral stenosis. Method: This is an observational experience report carried out at the Hospital Evangélico Goiano, during a cardiac surgery for mitral valve replacement in a 41-year-old female patient. The observation encompassed the application of the Safe Surgery Protocol up to the performance of the bilateral ultrasound-guided parasternal block with 0.55% Ropivacaine and Dexmedetomidine. Results: The experience enabled the understanding of the technical principles of the block, the importance of ultrasound anatomical visualization, the role of multidisciplinary teamwork in facing challenges such as vascular access difficulties, and the application of the safety checklist. The technique showed benefits such as reduced opioid consumption and early ventilatory recovery. Conclusion: The activity integrated theory and practice, contributing to the technical and ethical training of the students. Direct exposure to regional anesthesia reinforced the value of humanization and safety in perioperative care.
References
¹COSTA, Car; NETO, Silva; VIEIRA, J. F. Ultrasound-guided parasternal intercostal nerve block for perioperative analgesia in cardiac surgery: A randomized clinical trial. J Cardiothorac Vasc Anesth, v. 37, n. 2, p. 222–229, 2023.
²HASANBEIGI, D.; AGHAEI, H. Efficacy of dexmedetomidine in combination with local anesthetics for regional blocks: A systematic review and meta-analysis. J Pain Res, v. 15, p. 355–367, 2022.
³SANDEEP, Bhushan et al. A comparison of regional anesthesia techniques in patients undergoing video-assisted thoracic surgery: A network meta-analysis. International journal of surgery (London, England), v. 105, n. 106840, p. 106840, 2022.
SCHNABEL, Alexander et al. Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis: A meta-analysis and trial sequential analysis. European journal of anaesthesiology, v. 35, n. 10, p. 745–758, 2018.
SCIMIA, Paolo et al. A modified approach to a parasternal block: A case report. A&A practice, v. 17, n. 1, p. e01644, 2023.
SHARMA, Santosh; MISTRY, Tuhin; SONAWANE, Kartik. Superficial parasternal intercostal plane block: Anatomical landmark-guided technique. Indian journal of anaesthesia, v. 68, n. 9, p. 833–835, 2024.
TUPPER, Haley I.; VELOTTA, Jeffrey B. Expanding clinicians’ armamentarium for regional pain control after thoracic surgery. Journal of thoracic disease, v. 15, n. 5, p. 2359–2362, 2023.
