Ultrasound-guided bilateral parasternal block: A boon for managing pain after sternal fracture/dislocation

Sternal fractures are high velocity injuries which is associated with thoracic or lumbar vertebral fractures. Severe pain associated with sternal fractures can lead to impaired ventilation, low partial pressure of arterial oxygen, need of non-invasive or invasive ventilation with an endotracheal tube thereby leading to significant morbidity. In a series of three patients with manubrium sternal dislocation, we administered continuous bilateral parasternal blocks and initiated infusion of local anesthetics for different periods of time in all patients. The high pain scores drastically decreased followed by improved spontaneous ventilation. There was improvement in partial pressure of oxygen in arterial blood gas. None of the patient required a non-invasive or invasive ventilation. The spread of local anesthetic using injection of radio-opaque contrast through bilaterally placed parasternal catheters was followed by a computed tomography scan. This was done after obtaining informed consent from patient and waiver for scan. To the best of our knowledge, this is first report of successful pain management in patients who sustained manubrium - sternal dislocations using bilateral continuous catheters for a prolonged period.