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Superficial Parasternal Intercostal Plane Block for Pain Control Following Thymectomy via Midline Sternotomy: A Case
Onur Baran1, Ayhan Şahin, Cavidan Arar
1From the Department of Anesthesiology and Reanimation, Medical Faculty, Tekirdağ Namik Kemal University, Tekirdağ, Turkey.
A&A Practice
|October 13, 2025
Summary
A superficial parasternal intercostal plane (S-PIP) block effectively managed pain after sternotomy for myasthenia gravis. This opioid-sparing technique enhanced recovery in a high-risk patient.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pain Management
Background:
- Myasthenia gravis patients undergoing thymectomy often face significant postoperative pain.
- Opioid analgesia, commonly used, carries risks like respiratory depression and prolonged recovery.
- Minimizing opioid exposure is crucial for high-risk surgical patients.
Purpose of the Study:
- To evaluate the efficacy of a bilateral ultrasound-guided superficial parasternal intercostal plane (S-PIP) block for postoperative pain control.
- To assess the opioid-sparing potential of the S-PIP block in a patient undergoing sternotomy for thymectomy.
- To highlight the S-PIP block as a safe analgesic strategy in complex thoracic surgery.
Main Methods:
- A 53-year-old male with myasthenia gravis received a bilateral ultrasound-guided S-PIP block with 0.25% bupivacaine prior to sternotomy.
- Postoperative pain was managed with paracetamol and dexketoprofen.
- Pain scores and the need for systemic opioids were monitored.
Main Results:
- No systemic opioids were required for postoperative analgesia.
- Patient-reported pain scores remained below 4 during the initial 24 hours post-surgery.
- The patient experienced an uneventful recovery with effective pain management.
Conclusions:
- The superficial parasternal intercostal plane (S-PIP) block is a safe and effective opioid-sparing analgesic technique for sternotomy.
- This regional anesthesia approach can significantly improve postoperative recovery in patients with myasthenia gravis.
- Ultrasound-guided S-PIP block offers a valuable alternative to systemic opioids in thoracic surgery.
